Physician Clinical Reviewer - Pediatric Rheumatology- Remote

Prime Therapeutics

Remote, US
Base: $90.87 - $154.33 ph; bonus/equity: not speci...
Fully remote
5 years clinical experience required
Review medical necessity guidelines
Communicate with physicians via phone
Prime Therapeutics seeks a purpose-driven Physician Clinical Reviewer to join their utilization management team

Job Summary

  • Prime Therapeutics seeks a purpose-driven Physician Clinical Reviewer to join their utilization management team.
  • The role involves reviewing complex cases where initial determinations cannot be made and discussing them with requesting physicians.
  • Candidates must ensure strict compliance with Prime's policies as well as URAC and NCQA guidelines.

Matching Summary

Prime Therapeutics seeks a purpose-driven Physician Clinical Reviewer to join their utilization management team.

Salary

Base: $90.87 - $154.33 per hour; Bonus/Equity: Not specified; Benefits: Refer to benefits page

Skills & Requirements

Must-have

  • 5 years clinical experience required
  • Review medical necessity guidelines
  • Communicate with physicians via phone
  • Document all provider communications
  • Ensure URAC and NCQA compliance

Nice-to-have

  • Experience with inter-rater reliability training
  • Ability to assist initial reviewers
  • Participation in research activities
  • Willingness to attend hearings if requested

Key Requirements

  • MD, DO, or MBBS degree required
  • Minimum 5 years of clinical experience
  • Must be eligible to work in the US without visa sponsorship

Work Rights

Must be eligible to work in the United States without need for work visa or residency sponsorship

Tailored Resume

Cover Letter