Itlearn360
Secondary Physician Reviewer at Greenlife Healthcare Staffing Raceland, KY
Itlearn360, Raceland, Kentucky, United States
Overview
Secondary Physician Reviewer - Russell, KY (#R10154)
Location:
Russell, KY Employment Type:
Full-time Hourly Rate:
$115.00 - $120.00/hour
About 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.
Requirements Qualifications
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
Benefits Why Join Us?
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
#J-18808-Ljbffr
Location:
Russell, KY Employment Type:
Full-time Hourly Rate:
$115.00 - $120.00/hour
About 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.
Requirements Qualifications
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
Benefits Why Join Us?
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
#J-18808-Ljbffr