Secondary Physician Reviewer

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.

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

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