Remote Physician Reviewer 30182
Company: Solving IT
Location: Atlanta
Posted on: June 26, 2025
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Job Description:
One of the largest health insurers in the nation is focused on
continuously building an industry-defining, world-class IT
capability. Healthcare is forever evolving, especially due to
emerging technologies, making this a great experience to add to
your resume. Come join their winning team! This contract role as a
Remote Physician Reviewer is responsible for evaluating clinical
service requests made by an organization's members and providers.
Pay Rate: $105 per hour Responsibilities: • Evaluates clinical
service requests made by an organization's members and providers. •
Uses clinical judgment in conjunction with organization's criteria
to adjudicate these requests. • Provide clinical leadership in
other areas of the organization. • Identify opportunities to manage
members' clinical situations with a view toward creative problem
solving and anticipation of possible future clinical problems for
the member. • Participate in the process to evaluate clinical
service requests. • Practice anticipatory case management for
members whose cases come for review, in partnership with case
managers. • Participate in the Physician Review Units' appeal
process of service denials. • Participate in the development of
Physician Review Units' policies and procedures. • Actively
participates in all unit continuous quality improvement activities.
• Perform other duties as assigned by the Medical Director. Job
Requirements: • Board Certified (ABMS) M.D. or D.O, unrestricted
and active license to practice medicine requested and 5 years
clinical experience to include inpatient experience, or any
combination of education/experience that would provide an
equivalent background. • Must have understanding of managed care
and demonstrate PC proficiency, as file review will be done via
computer in most cases. (Note: Position does not provide direct
patient care or medical diagnosis.) Preferred Job Requirements: •
10 years clinical experience • Experience with managed care and
utilization management. Benefits : Solving IT, a Woman and LGBTQ
owned and operated organization is thrilled to provide a
comprehensive benefit package to all our W2 employees and their
families, regardless of gender. We are proud to offer five diverse
health plan options as well as a PPO dental plan through Blue Cross
Blue Shield, Term Life/AD&D Insurance, and a 401(k) Savings
Plan. Solving IT covers a portion of the health and dental premiums
for our employees. As you progress in your professional journey,
Solving IT is dedicated to accommodating your evolving preferences
and matching you with fulfilling projects. We champion equality and
embrace diversity in all its forms. Creating an atmosphere that
encourages varied perspectives to collaborate fosters personal
development, strengthens team unity, and contributes to the overall
success of the organization! Whether you're seeking your next
career challenge or aiming to stay abreast of industry trends,
Solving IT is committed to supporting your career advancement. We
actively encourage applications from all backgrounds and utilize
the most up-to-date market insights and compensation data to ensure
that you receive not just advice, but the complete Solving IT
Experience.
Keywords: Solving IT, Athens , Remote Physician Reviewer 30182, Healthcare , Atlanta, Georgia
