Physician Reviewer-Remote
Updated 12/02/25
$125.00
– $145.00
hourly
Oregon, Oregon, United States
Physician
Administrative/CEO
By applying you agree to our Terms of Service
Job at a glance
Degree Required
MD/DO
Position Type
Part-Time/Contract
Work Environment
Telemedicine
Visa Sponsorship
No
Job description
Job description
The Physician Reviewer performs real-time case reviews, applies evidence-based guidelines, and completes utilization management determinations for home health services. You will act as a clinical leader, ensuring medical necessity, supporting quality initiatives, and participating in peer-to-peer discussions with providers and health plan partners.
This is a dynamic role ideal for a physician who thrives in a virtual environment, values clinical integrity, and enjoys contributing to quality improvement and compliance efforts.
Job Responsibilities
Apply clinical judgement using evidence-based guidelines for pre-service, concurrent, retrospective, and claims reviews of home health services.
Review and document Potential Quality Issues (PQIs).
Identify and record inappropriate utilization patterns and trends.
Participate in inter-rater reliability reviews.
Conduct Peer-to-Peer case discussions with payer medical directors, PCPs, specialists, and hospitalists.
Build and maintain strong relationships with physicians, nursing, therapy teams, and interdisciplinary staff.
Provide medical guidance for utilization management and quality improvement initiatives in line with health plan, regulatory, NCQA, and compliance standards.
Attend quarterly UM, QM, and Compliance Committee meetings (as assigned).
Contribute to policy development and review.
Evaluate clinical quality concerns and identify opportunities for quality improvement and reduced variation in care.
Support provider education and implementation of recommendations that improve utilization and care outcomes.
Ensure all UM activities meet regulatory requirements and organizational standards.
Collaborate effectively in a virtual team environment.
Qualifications
Licensure required in OR and/or TN.
Board certified (Primary Care preferred: Internal Medicine, Family Medicine, Gerontology, PM&R).
Actively practicing physician with 10+ years’ clinical experience. Licensed in OR and/or TN.
Background in Health Administration, Health Financing, or Insurance is beneficial.
Board Certification through ABMS.
Working Hours
Skills
By applying you agree to our Terms of Service