Top 778 Medical case reviewer Jobs

Medical Peer Reviewer
Healthfirst —Remote
- $122,907 - $188,020 a year
- 8 hour shift
- Medicine
- Mid-level
- Communication skills
- Paid holidays
- Health insurance
MEDICAL REVIEWER
Zenith LifeScience —South Plainfield, NJ
- $100,000 - $120,000 a year
- Full-time
- Medicine
- Microsoft Excel
- English
Urologist- Independent Medical Reviewer
Managed Medical Review Organization —Remote
- Choose your own hours
- 5 years
- Patient care
- Senior level
Quick Apply
Nephrology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures —Remote
- Part-time
- Remote
- Medicine
- BC/BE
- Writing skills
- Flexible schedule
Occupational Medicine -Independent Medical Reviewer
Managed Medical Review Organization —Remote
- Choose your own hours
- Medicine
- 5 years
- Senior level
Quick Apply
Medical Consultant Reviewer - Internist PRN or Part-Time
COMAGINE HEALTH —Washington, DC
- $140 - $148 an hour
- Part-time
- Remote
- Medicine
- Internal Medicine
- Travel
- Paid parental leave
- Health insurance
Quick Apply
Dispute Resolution Reviewer I
TMF Health Quality Institute —Remote
- Full-time
- Remote
- Research
- Mid-level
- Associate's degree
- AD&D insurance
- Disability insurance
Dispute Resolution Reviewer III (Healthcare Professional)
TMF Health Quality Institute —Remote
- Full-time
- Remote
- Writing skills
- Research
- Mid-level
- AD&D insurance
- Disability insurance
Gastroenterology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures —Remote
- Part-time
- Remote
- BC/BE
- Writing skills
- English
- Flexible schedule
Second Level Reviewer I PRN Remote
AdventHealth Corporate —Altamonte Springs, FL
- $31.82 - $59.17 an hour
- PRN
- Remote
- Background check
- Nursing
- RN License
- Paid parental leave
- Disability insurance
14d
Hematology/Oncology, Physician Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures —Remote
- Part-time
- Remote
- Medicine
- BC/BE
- Writing skills
- Flexible schedule
Radiology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures —Remote
- Part-time
- Remote
- Medicine
- BC/BE
- Writing skills
- Flexible schedule
Surgical Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures —Remote
- Part-time
- Remote
- Medicine
- Surgery
- BC/BE
- Flexible schedule
Endocrinologist - Independent Reviewer for Disability Appeals
Emperion —Remote
- $100 - $1,000 an hour
- Part-time
- Remote
- Mid-level
- 3 years
- Communication skills
Quick Apply
Cardiology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures —Remote
- Part-time
- Remote
- Medicine
- BC/BE
- Writing skills
- Flexible schedule
Medical Consultant Reviewer- Pediatrician PRN D.C.
COMAGINE HEALTH —Washington, DC
- $140 - $150 an hour
- Part-time
- Remote
- Medicine
- Travel
- Ability to sit for extended periods
- Paid parental leave
- Health insurance
Quick Apply
Physician Reviewer
MedReview —Remote
- $230,000 a year
- Full-time
- Remote
- Medicine
- 5 years
- BC/BE
Quick Apply
Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures —Washington, DC
- Part-time
- Remote
- Surgery
- BC/BE
- Writing skills
- Flexible schedule
COMPLEX MEDICAL CASE REVIEWER
Agency HRA/DEPT OF SOCIAL SERVICES —Manhattan, NY
- $118,749 a year
- Full-time
- Nursing
- Management
- Psychiatry
- Loan forgiveness
- Food provided
PM&R -Independent Medical Reviewer
Managed Medical Review Organization —Remote
- Choose your own hours
- Medicine
- 5 years
- BC/BE
Quick Apply

I want to receive the latest job alert for medical case reviewer

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Medical Peer Reviewer

Healthfirst -
Remote

Apply Now

Job Details

Part-time
$122,907 - $188,020 a year

Benefits

Paid holidays
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance

Qualifications

Medical License

Full Job Description

Job Profile Summary A vital role of the CMO Administration team, the Medical Peer Reviewer plays a critical role in consulting on medical necessity in the context of utilization management and ensuring adherence to internal Healthfirst and external regulations.

Duties/Responsibilities:

The Medical Peer Reviewer will assess/review requests for authorization, and claims payment, based on medical records and internal Healthfirst information and make informed clinical judgments and recommendations.
The Medical Peer Reviewer will render determinations in the format and within timeframes to follow Regulatory and Operational policies.
The Medical Peer Reviewer will:
Maintain productivity standards.
Collaborate with Utilization Management and Care Management and medical departments as needed, reviews and manages cases/caseload from multiple lines of businesses
Demonstrate the ability to be flexible when case load volume fluxes and when Leadership requests changes in case priorities to support our members/internal medical departments as needed
Complete mandatory Company compliance training and training in new systems and software.
Enter each day’s hours worked in Workday, on the same day.
Perform other duties as assigned
Responsibilities may be adjusted based on changing needs of the organization.

Weekday Requirements:

The Medical reviewer requires 25 hours a week of coverage. The configuration of the 25 hours may change with the business needs, with a minimum of 3 days a week, 2 days at 8 hours and one day at 9 hours. Maximum of 5 days a week of coverage
The Medical Reviewer will take 8 hours off during the week after being primary coverage for a weekend, usually the following Friday.
Each Medical Reviewer will cover one legal holiday /year and will be compensated Holiday pay and straight hours worked
The Medical Reviewer is eligible for Paid Time Off (PTO) and is required to plan and schedule time off with their direct supervisor following the Company policy.

Weekend Requirements:

Each Medical Reviewer is required to be primary coverage one weekend a month
Each Medical Reviewer is required to be available as back up, if needed, one weekend a month
Dental Reviewers have a fixed schedule

Minimum Qualifications:

Licensed M.D. or D.O. or D.M.D. or D.D.S.

Board Certified in a specialty recognized by the American Board of Medical Specialties

Preferred Qualifications:

Board Certified in Internal Medicine , Family Practice, Emergency Medicine
Previous, relevant experience in utilization management and clinical practice
Knowledge of Medicare, Medicaid, and MLTC plans
Time management, critical thinking, communication, and problem-solving skills
Knowledge of UM/QM case philosophies and reporting requirements to state and federal agencies
Knowledge of member satisfaction/incident management and regulations
Knowledge of quality improvement methodologies

Compliance & Regulatory Responsibilities: Ensures compliance to internal Healthfirst and external regulations.

Licensed M.D. or D.O. or D.M.D. or D.D.S.
Annual Compliance and other training as assigned, may include but not limited to hardware, software, and system training upgrades
Annual Inter-Rater Reliability (IRR) Testing
Complies with the Healthfirst Conflict of Interest Policy for Professionals

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $122,907 - $188,020

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

Apply Now

Refine Your Search

medical case reviewer jobs

Medical Peer Reviewer

MEDICAL REVIEWER

Urologist- Independent Medical Reviewer

Nephrology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)

Occupational Medicine -Independent Medical Reviewer

Medical Consultant Reviewer - Internist PRN or Part-Time

Dispute Resolution Reviewer I

Dispute Resolution Reviewer III (Healthcare Professional)

Gastroenterology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)

Second Level Reviewer I PRN Remote

Hematology/Oncology, Physician Medical Case Reviewer (Remote, Part-Time, Flexible Hours)

Radiology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)

Surgical Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)

Endocrinologist - Independent Reviewer for Disability Appeals

Cardiology Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)

Medical Consultant Reviewer- Pediatrician PRN D.C.

Physician Reviewer

Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)

COMPLEX MEDICAL CASE REVIEWER

PM&R -Independent Medical Reviewer

I want to receive the latest job alert for medical case reviewer

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected