Licensed Physician Reviewer - Ortho (remote)

Medical Care of Boston Management Corporation(3 months ago)

RemotePart TimeSenior$198,797 - $283,995Utilization Management

About this role

The Physician Reviewer is a licensed physician who supports the organization’s utilization management and clinical appropriateness program across assigned markets. The role works with health plans and internal teams to ensure appropriate care decisions and contributes to the development of delegated utilization management processes. It is part of a growing primary care-focused organization serving senior populations.

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Required Skills

Clinical Appropriateness
Utilization Review
Analytical Thinking
Problem Solving
Communication
Organization
Microsoft Office

Qualifications

Graduate of Accredited Medical School
Unrestricted Medical License
Internal Medicine Residency
Family Practice Residency
Orthopedic Surgery Fellowship
Board Certification (Residency)
Board Certification (Orthopedic Surgery)

About Medical Care of Boston Management Corporation

cms.gov

The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services (HHS) that administers the nation's major healthcare programs, including Medicare and Medicaid. CMS is responsible for overseeing the healthcare system in the United States, ensuring access to high-quality healthcare services and improving health outcomes for its beneficiaries. Through its initiatives and regulations, CMS aims to provide a more transparent healthcare system and reduce costs while enhancing care delivery across the nation.

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