Physician Clinical Reviewer- Pediatric Neurology- REMOTE

Prime Therapeutics is seeking a Physician Clinical Reviewer- Pediatric Neurology- REMOTE. The role involves reviewing medical requests, interacting with physicians and health plan members, and ensuring consistency in the physician review process. The ideal candidate has a DO, MBBS, or MD degree, 5+ years of clinical experience, and can work in the United States without visa sponsorship.

Requirements

• Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer
• Discusses determinations with requesting physicians or ordering providers
• Provides clinical rationale for standard and expedited appeals
• Utilizes medical/clinical review guidelines and parameters
• Participates in on-going inter-rater reliability training and testing
• Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process

Benefits

• Generous Paid Time Off
• 401k Matching
• Retirement Plan
• Visa Sponsorship
• Four Day Work Week