Conduct independent utilization reviews for nephrology cases, focusing on clinical appropriateness and medical necessity determinations. This role is fully remote and centered on reviewer-level decision-making for patient records, with daytime availability needed for peer-to-peer conversations.
Key Responsibilities
- Conduct independent utilization reviews for nephrology-related cases.
- Review clinical records and apply medical necessity criteria.
- Participate in peer-to-peer conversations as needed.
- Work within HIPAA requirements for confidential handling of patient information.
- Use company review processes and policies to complete determinations.
Required
- MD or DO degree.
- Current Texas state medical license.
- Board certification in Nephrology.
- At least 5 years of clinical experience, including residency.
- Daytime availability for peer-to-peer conversations.
Benefits & Perks
- Fully remote work from anywhere in the U.S. for HIPAA-compliant access.
- Flexible independent contractor (1099) arrangement.
- No minimum weekly commitment stated.
- Covered under the organization's Errors and Omissions policy.