[Remote] Medicaid Peer Reviews
Note: The job is a remote job and is open to candidates in USA. Commence is a company focused on data-centric transformation in healthcare, aiming to elevate health outcomes through quality data-driven solutions. They are seeking Physicians (MD/DO) to join their network of clinical reviewers, responsible for conducting independent case reviews and ensuring the quality of care for military members and their families.
Responsibilities
- Conduct independent, remote case reviews evaluating medical necessity, appropriateness, or quality of care
- Provide evidence-based assessments and written determinations following established clinical guidelines and review criteria
- Support case types including: Utilization review, Appeals and hearings, Quality of care and standard of care concerns
- Uphold the highest standard of clinical integrity, neutrality, and objectivity
Skills
- Hold an active, unrestricted U.S. license as an MD or DO
- Board certified in your specialty by an ABMS or AOA-recognized board within the State of Maryland or surrounding states
- Minimum of 5 years of clinical experience in your specialty post residency or fellowship
- Currently practicing and seeing patients an average of at least 20 hours per week over the past 30 days
- Strong written communication skills and attention to detail
- Ability to review cases objectively and meet turnaround deadlines
- Comfortable working independently in a secure, remote environment
- Current High Priority Specialties: Dentistry, Dermatology, Endocrinology, Nephrology, Ophthalmology, Orthopedics, Otolaryngology, Pediatrics, Pharmacy, Oncology
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