• Remote role responsible for the administration of medical services, to ensure the appropriate and most cost effective medical care is received.
• May provide clinical consultation and serve as clinical/strategic advisor to enhance clinical operations and a resource to clinical staff
• Supports clinicians to ensure timely and consistent responses to members and providers.
• May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determinations
• Interprets medical policies and clinical guidelines.
• Requires MD or DO and current Board certification
• Must possess an active unrestricted medical license to practice medicine in CA
• Standard hours are 8 AM 5 PM PT M-F
• Available to work weekends and holiday s on a rotation assignment for call coverage
• Ensures timely review of all case work to meet business turnaround times
• Reports to Managing Medical Director and works with a staff of 3 other MD reviewers

Interested?

Robert Hewitt, MSc.

Maxim Healthcare