Secondary Physician Reviewer
- Raceland, KY
- Permanent
- Full-time
Employment Type: Full-time
Hourly Rate: $115.00 - $120.00/hourAbout 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.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.
- Education: MD/DO from an accredited institution
- Licensure: Active medical license (good standing)
- Experience:
- At least 5 years’ experience in clinical review, hospital medicine, or utilization management.
- 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
- 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 hour Phone 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