Review radiology claims, Treatment Authorization Requests, imaging records, and supporting documentation to determine medical necessity, coverage, and appropriateness for California healthcare programs. This role focuses on physician-level radiology review rather than direct patient care, with work centered on interpreting complex records, documenting decisions, and applying medical policies and regulatory guidelines. The position is remote and requires collaboration with physicians, nurses, clinical specialists, operations teams, and business partners.
Key Responsibilities
- Review radiology-related claims, TARs, medical records, and supporting clinical documentation.
- Evaluate imaging services against medical policies, coverage requirements, and clinical standards.
- Provide physician-level clinical review and rationale for complex radiology cases.
- Support medical necessity and appropriateness determinations for requested or billed services.
- Document review findings, decisions, and clinical rationale clearly and accurately.
- Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners.
- Maintain current knowledge of radiology standards, medical policies, coverage requirements, and regulatory guidelines.
- Meet quality, accuracy, productivity, and turnaround-time expectations.
Required
- MD or DO with radiology experience.
- At least 3 years of experience as a radiologist in private, academic, or government practice.
- Current, active California physician license in good standing.
- Ability to maintain unrestricted licensure and required credentials.
- Strong oral and written communication skills.
- Ability to interpret complex radiology-related records and documentation.
Preferred
- Experience reviewing medical necessity or utilization management cases.
- Familiarity with medical review workflows and payer or program policy requirements.
Benefits & Perks
- Remote work environment.
- Monday through Friday schedule.
- Flexible hours.
- Full-time role.
- Pay range of $150,000 to $175,000 per year.
- Flexible vacation policy for salaried full-time candidates.
- 401(k) employer match.
- Comprehensive health benefits.
- Educational assistance.
- Leadership and technical development academies.