Texas Licensed Physician Reviewer

Evaluating clinical service requests, the contract Texas Licensed Physician Reviewer will utilize clinical judgment to adjudicate requests and provide clinical leadership while working remotely. Key responsibilities Evaluate clinical service requests and apply organization's criteria for adjudication Participate in the Physician Review Units' appeal process and contribute to policy development Engage in anticipatory case management and continuous quality improvement activities Required qualifications Board Certified (ABMS) M.D. or D.O. with an unrestricted and active medical license Minimum of 5 years of clinical experience, including inpatient experience Understanding of managed care principles Proficiency in computer applications for file review