Secondary Physician Reviewer - Russell, KY | $120.00/hour

Job description

Secondary Physician Reviewer – Russell, KY 41169 (#R10154)
📍 Location: Russell, KY 41169
📅 Employment Type: Full-time
💰 Hourly Rate: $115.00 – $120.00/hr

🟩 🔎 Position Overview
✔️ Drive medical efficiency and quality by conducting second-level medical necessity reviews in a high-impact utilization management role for a leading healthcare organization.

🟩 ✅ Why Join Us?
✔️ Earn up to $120/hr for your clinical expertise
✔️ Flexible support schedule:
- On-Site: Mon–Fri, 8:00 a.m. – 5:00 p.m. → $115/hr
- Phone Support: 7:30 a.m. – 11:59 p.m. → $115 + $5/hr
✔️ Work-Life Balance – Remote and phone-based flexibility
✔️ Influence payer policy compliance & clinical standards
✔️ Premium, long-term opportunity in healthcare leadership

🟩 📌 Qualifications
✔️ MD or DO from an accredited institution
✔️ Active U.S. medical license in good standing
✔️ 5+ years’ experience in:
- Clinical reviews, hospital medicine, or utilization management
- CMS, Medicaid, and commercial payer regulations
✔️ Strong knowledge of: InterQual, MCG, and clinical review protocols
✔️ Familiarity with secure documentation systems and EHRs
✔️ Skilled communicator and critical decision-maker

🟩 🧠 Key Responsibilities
✔️ Conduct second-level reviews (concurrent & retrospective)
✔️ Determine admission status, LOS, and care level appropriateness
✔️ Evaluate readmission cases within a 30-day window
✔️ Support escalations and appeals for:
Medicare, Medicaid, Commercial payers
Coding denials and government audits
✔️ Present monthly reporting and utilization trends
✔️ Ensure strict compliance with HIPAA and confidentiality