Full job description

STATEMENT OF ROLE & RESPONSIBILITY

POSITION TITLE: ENT Physician Clinical Reviewer

SCOPE OF ROLE & RESPONSIBILITIES

Clinical review of internal and/or external review cases for medical necessity, treatment appropriateness, or administrative compliance.
Thorough review of all submitted information, documentation of determination, clinical rationale, and citation of sources used to support decision within the specified timeframe.
Complete Peer-to-Peer phone calls with providers when scheduled.

QUALIFICATION REQUIREMENTS

Have current, non-restricted licensure or certification as required for clinical practice in a state of the United States.
Have at least five (5) years full-time equivalent experience providing direct clinical care to patients;
Have a scope of licensure or certification and professional experience that typically manages the medical condition, procedure, treatment, or issue and are clinical peers for each case under review.
If an M.D. or D.O. has board certification by a medical specialty board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA); and if a D.P.M., has board certification by the American Board of Podiatric Surgery (ABPS) or the American Board of Podiatric Orthopedics and Primary Podiatric Medicine
If performing External Review, must meet all of the above and have experience providing direct clinical care to patients within the past three (3) years.

Job Types: Part-time, Contract

Benefits:

License/Certification:

Work Location: Remote

BHM Healthcare Solutions