Physician Clinical Reviewer - Rheumatology- REMOTE
Prime TherapeuticsHome
Posted April 30, 2026
181740 - 308660 USD
Full Time
About the Company
Prime Therapeutics LLC (Prime) is a diversified pharmacy solutions organization. We offer innovative pharmacy benefit management, specialty and medical drug management, and state government solutions to millions of people across the country. At Prime, we’re reimagining pharmacy solutions to provide the care we’d want for our loved ones. We challenge the way it’s always been done to develop intelligently designed solutions that deliver savings, simplicity and support to help people achieve better health.
Job Description
Prime Therapeutics is seeking a Physician Clinical Reviewer - Rheumatology to review cases and provide timely medical review of service requests. The ideal candidate will have a DO, MBBS, or MD degree and 5+ years of clinical experience.
Requirements
- Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer
- Discusses determinations with requesting physicians or ordering providers, when available
- Provides clinical rationale for standard and expedited appeals
- Utilizes medical/clinical review guidelines and parameters to assure consistency in the physician review process
- Ensures documentation of all communications with medical office staff and/or physician/provider
- 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 (not applicable)
- Four Day Work Week
- Generous Parental Leave
- Tuition Reimbursement
- Relocation Assistance