Physician Reviewer (California Licensed) – Remote

Responsibilities:

  • Review approximately 20 prior authorization (auth) requests daily, Monday–Friday.
  • Complete all reviews and submit them to the UM Coordinator before 3:00 PM PST.
  • Evaluate each auth by reviewing:
    • Member's medical records
    • Auth request details
    • Relevant clinical criteria (CMS, Health Plan, InterQual, MCG)
  • For denied or partially approved requests, provide:
    • A clear, detailed rationale
    • Cited criteria including name, title, and number
  • Monitor your assigned auth queue in the UM system.
  • Ensure that all auths are reviewed and returned within the assigned turnaround times (TAT), color-coded as:
    • Red: Past due
    • Yellow: Nearing deadline
    • Green: Over 24 hours remaining
  • Notify the team in advance for scheduled time off; unreviewed auths must be carried over and completed the following day.
  • Provide 24-hour notice for unscheduled time off, when possible.
  • Collaborate with the UM team and follow protocols for criteria application and review submission.

Training Provided:

  • Training on our Prior Authorization system and workflow
  • Instruction on how to cite criteria appropriately
  • Criteria documents will be attached to each auth for your review

Additional Notes:

  • This is a remote, part-time contract role
  • Reviewers are expected to consistently meet the 20-auths-per-day quota
  • Queue monitoring and daily communication with the UM team are essential for success.The pay range for this position at commencement of contract is expected to be between $6,000.00 - $6,000.00 per month.
Requirements:
  • Active, unrestricted California medical license (MD or DO)
  • Strong clinical decision-making and documentation skills
  • Familiarity with CMS guidelines, InterQual, MCG, and major health plan criteria
  • Ability to work independently and meet strict daily deadlines
  • Comfortable working with digital systems and remote teams


Compensation: $6000.00 - $6000.00/month
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