Medical Clinical Reviewer Doctor (MD/DO) (Part-time, Remote) at Integrity Management Services, Inc | chakrie

Requirements

Additional Requirements

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school.
Current, active, and unrestricted license to practice medicine in at least one U.S. state or jurisdiction.
Medical license must be in good standing, with no current restrictions, suspensions, or disciplinary limitations that would affect the ability to perform clinical reviews.
Minimum of two (2) years of professional clinical experience.
Strong knowledge of medical terminology, clinical practice, treatment planning, medical documentation, and generally accepted standards of care, with the ability to interpret medical records, diagnostic results, imaging, treatment plans, and other clinical documentation.
Strong analytical and critical-thinking skills with the ability to independently evaluate clinical information and develop objective, evidence-based clinical determinations.
Ability to clearly and concisely document clinical review findings, conclusions, and supporting rationale.
Strong attention to detail, organizational skills, and the ability to work independently while meeting established quality, productivity, and project timelines in a remote environment.
Board certification or board eligibility in a medical specialty relevant to the assigned reviews.
Experience in internal medicine, family medicine, psychiatry, or another specialty applicable to the review assignment.
Experience treating Medicaid populations or working with Medicaid programs.
Previous experience conducting medical record review, claims review, utilization review, medical necessity review, peer review, payment integrity review, or retrospective clinical review.
Familiarity with Medicaid coverage policies, medical necessity requirements, and healthcare program integrity concepts.
Experience evaluating potentially improper, excessive, unsupported, or medically unnecessary healthcare services.
Familiarity with medical coding, including CPT/HCPCS and ICD-10-CM, and the relationship between clinical documentation and billed services.
Experience supporting health plans, Medicaid agencies, Medicare, other government healthcare programs, or healthcare program integrity initiatives.

Responsibilities

A clear overview of what is expected, written by the people who posted it, with every detail you need to decide.

Qualifications, experience and the skills that matter most, along with anything that would make you stand out.

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Skills & expertise

Qualifications, experience and the skills that matter most, along with anything that would make you stand out.

Practical next steps, the documents to prepare and the dates to keep in mind before you apply or get in touch.

Contact details, links to the official source and the notes our team adds after checking each listing by hand.

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Salary & benefits

A clear overview of what is expected, written by the people who posted it, with every detail you need to decide.

Qualifications, experience and the skills that matter most, along with anything that would make you stand out.

Practical next steps, the documents to prepare and the dates to keep in mind before you apply or get in touch.

Contact details, links to the official source and the notes our team adds after checking each listing by hand.

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Medical Clinical Reviewer Doctor (MD/DO) (Part-time, Remote)

Summary

Requirements

Additional Requirements

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Summary

Requirements

Additional Requirements

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Report this Job / Company (রিপোর্ট)

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