Physician Reviewer (Behavioral Health)
Blue Cross Blue Shield of Massachusetts(2 months ago)
About this role
The Physician Reviewer evaluates clinical service requests from BCBSMA members and providers using clinical judgment alongside BCBSMA criteria. This part-time role (approximately 30 hours/week) supports the Physician/Psychologist Review Unit and may provide clinical leadership and guidance across the organization. The position is eligible for a Flex persona and can be performed remotely.
Required Skills
- Clinical Judgment
- Case Management
- Appeals
- Policy Development
- Quality Improvement
- Communication
- Negotiation
- Microsoft Word
Qualifications
- MD Degree
- Board Certification (Addiction Psychiatry or Addiction Medicine, General Psychiatry)
- Unrestricted Medical License (MA or relevant state)
- BCBSMA Credentialed Provider
- Active Clinical Practice
About Blue Cross Blue Shield of Massachusetts
bluecrossma.orgBlue Cross Blue Shield of Massachusetts brings health insurance plans, medical claims, insurance coverage, benefits and telehealth via MyBlue Web & App
View more jobs at Blue Cross Blue Shield of Massachusetts →Apply instantly with AI
Let ApplyBlast auto-apply to jobs like this for you. Save hours on applications and land your dream job faster.
More jobs at Blue Cross Blue Shield of Massachusetts
Sr. Manager, Contract Development
Blue Cross Blue Shield of Massachusetts(4 days ago)
Ancillary Network Specialist
Blue Cross Blue Shield of Massachusetts(4 days ago)
Information Security Risk Analyst
Blue Cross Blue Shield of Massachusetts(5 days ago)
Project Manager II
Blue Cross Blue Shield of Massachusetts(5 days ago)
Similar Jobs
Psychologist Reviewer - part time
Elevance Health(1 month ago)
Physician Reviewer - Neurologist - WA L&I
Dane Street, LLC(1 year ago)
Psychologist Reviewer - Georgia
Elevance Health(1 month ago)
Licensed Physician Reviewer - Neurology (remote)
Medical Care of Boston Management Corporation(2 months ago)
Pharmacist - Utilization Management (UM) - Remote
Highmark Health(27 days ago)
Physician Reviewer - Psychiatrist - WA L&I
Dane Street, LLC(1 year ago)