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Prime Therapeutics
Overview
This role involves providing timely medical review for service requests that do not initially meet medical necessity guidelines, often interacting with requesting physicians and providers. Responsibilities include discussing determinations, providing clinical rationale for appeals, and ensuring documentation accuracy according to established guidelines.
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Compensation
$91 - $154 / HOUR
Posted
9 days ago
The Physician Clinical Reviewer provides timely medical review of service requests that do not initially meet medical necessity guidelines, interacting with providers and staff as needed. Responsibilities include reviewing complex cases, discussing determinations with requesting physicians, providing clinical rationale for appeals, and ensuring compliance with various guidelines and policies.
The Physician Clinical Reviewer provides timely medical review of service requests that do not initially meet medical necessity guidelines, interacting with providers and staff as needed. Responsibilities include discussing determinations with requesting physicians, providing clinical rationale for appeals, and ensuring documentation accuracy according to established guidelines.
3 months ago
