Job Description

Secondary Physician Reviewer - Russell, KY 41169 (#R10154)
Employment Type: Full-Time
Hourly Rate: $115.00 - $120.00/hour

Position Overview
Take a lead role in utilization management and second-level medical necessity reviews to ensure optimal care delivery and compliance across payer types. This high-impact role supports effective resource allocation while upholding the highest standards of care in a dynamic healthcare setting.

Compensation & Perks
✅ $115/hour on-site (Monday-Friday, 8:00 a.m. - 5:00 p.m.)
✅ $115/hour + $5/hour phone support (7:30 a.m. - 11:59 p.m., weekends and holidays included)
✅ Premium-level compensation structure
✅ Full-time position with consistent schedule
✅ Influence system-wide utilization strategies

Qualifications
✅ MD or DO from an accredited medical school
✅ Active, unrestricted medical license
✅ Minimum 5 years' experience in hospital medicine, utilization management, or clinical review
✅ In-depth knowledge of CMS, Medicaid, and Commercial payer rules
✅ Proficient in InterQual, MCG, and other review criteria
✅ Skilled in using electronic documentation and secure communications tools
✅ Peer-level review experience for various case types
✅ Strong analytical, communication, and HIPAA-compliant decision-making skills

Key Responsibilities
✅ Perform second-level reviews for concurrent and retrospective medical necessity determinations
✅ Assess admission status, length of stay, and appropriate level of care
✅ Evaluate readmissions within 30 days for clinical relevance
✅ Support escalated first-level reviews and appeal cases
✅ Advise on Medicare, Medicaid, and Commercial payer criteria
✅ Review and respond to coding denial appeals and government audits
✅ Prepare monthly reports analyzing review outcomes
✅ Maintain strict compliance with HIPAA and secure data protocols
Employment Type: Full-Time
Salary: $ 115.00 120.00 Per Hour

Job Tags

Hourly pay, Full time, Weekend work, Monday to Friday,

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