Job Description

Secondary Physician Reviewer - Russell, KY (#R10154)

Location: Russell, KY
Employment Type: Full-time
Hourly Rate: $115.00 - $120.00/hour

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.

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

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

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.

Greenlife Healthcare Staffing – Empowering Healthcare Professionals, Enriching Lives.

We are committed to our core values: integrity, honesty, and transparencyFinding a new position as a physician or allied health professional or filling a critical vacancy in your practice, clinic, hospital, or skilled care facility can be stressful and time-consuming.At Greenlife our mission is to make this process easier for you and help you through all the steps necessary to find that perfect new position or the healthcare professional to round out your team.We understand that every situation is different and our approach reflects that: we value personalized interaction with job seekers and employers, our searches are customized not cookie-cutter and our results speak for themselves: Happy job seekers and employers who found the right professional match through our services.

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