Secondary Physician Reviewer
Secondary Physician Reviewer
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Job Description
Secondary Physician Reviewer - Russell KY (#R10154)
Location: Russell KY
Employment Type: Full-time
Hourly Rate: $115.00 - $120.00/hour
About Greenlife Healthcare Staffing:
Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals clinics nursing homes multi-specialty groups and private practices to match talented individuals with roles that align with their skills and career goals.
Position Overview:
Lead utilization management efforts by conducting critical second-level medical necessity reviews. Ensure optimal resource allocation and compliance with CMS/payer guidelines while driving cost-effective high-quality patient care across diverse healthcare settings.
Why Join Us
- Competitive Compensation:On-Site: Monday - Friday 24/7 electronic correspondence availability(including weekends and holidays) 8:00 a.m. - 5:00 p.m. - $115.00 per hourPhone support from 7:30 a.m. - 11:59 p.m. - $115.00 $5.00 per hour
- Comprehensive Benefits:Premium compensation
- Professional Growth:
- Master federal/state payer regulations (CMS Medicaid Commercial)
- Influence system-wide resource utilization strategies
Qualifications:
- Education: MD/DO from an accredited institution
- Licensure: Active medical license (good standing)
- Experience:
- At least 5 years experience in clinical review hospital medicine orutilizationmanagement.
- Expertise in federal and state payer guidelines including CMS.
- Strong understanding of inpatient observation and outpatient criteria(e.g. InterQual MCG).
- Technical Skills:
- Experience with electronic documentation systems and secure communications platforms.
- Peer-level (physician) reviewers for a range of review/appeal tasks.
- Soft Skills:
- Analytical decision-making
- HIPAA compliance
Key Responsibilities:
- Conduct second-level medical necessity reviews for concurrent and retrospective cases.
- Determine admission status length of stay and appropriate level of care.
- Review readmission cases for clinical relevance within a 30-day window.
- Provide expert guidance for:
- Medicare Medicaid and Commercial payers
- First-level review escalations
- Coding denial appeals
- Government and Managed Medicare appeals
- Produce and present monthly reports and ongoing analysis of review outcomes.
- Ensure HIPAA-compliant communications and secure data handling.
How to Apply:Ready to shape healthcare resource efficiency Submit your Resume/CV to or call .
Greenlife Healthcare Staffing Empowering Healthcare Professionals Enriching Lives.
Employment Type
Hourly
