Job Description

Job Description

Position Title: Physician Reviewer (Remote – Texas License Required)

Schedule:

• Monday through Friday, 7–8 hours per day (approximately 39 hours per week)
• Flexibility to work weekends (Saturday/Sunday) as needed

Compensation:

• $110 per hour

Location:

• Fully Remote
• Must hold active and unrestricted Texas Medical Licensure

Position Overview

The Physician Reviewer evaluates clinical service requests from members and providers, applying sound clinical judgment and organizational criteria to adjudicate requests. This role supports the organization's mission to ensure appropriate, high-quality care and efficient utilization of medical services.

Key Responsibilities

• Review and evaluate clinical service requests in alignment with organizational guidelines.
• Apply clinical expertise to manage members’ care needs and anticipate potential future medical issues.
• Collaborate with case managers to provide anticipatory case management for complex cases.
• Participate in the development and continuous improvement of Physician Review Unit policies and procedures.
• Contribute to quality improvement initiatives across the department.
• Perform additional duties as assigned by the Medical Director.

Qualifications

• Education: Board Certified M.D. or D.O. (ABMS)
• Licensure: Active, unrestricted license to practice medicine in the state of Texas
• Experience: Minimum of 5 years of clinical experience, including inpatient care
• Skills & Knowledge:
• Strong understanding of managed care principles
• Proficient in computer-based file review and documentation
• Note: This position does not involve direct patient care or medical diagnosis.

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