[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 Company Overview Commence delivers AI-driven healthcare data platform and clinical expertise that supports analytics, decisions, and workflow improvement. It was founded in undefined, and is headquartered in Virginia Beach, Virginia, USA, with a workforce of 501-1000 employees. Its website is https//commence.ai.