Location: Remote
Status: Contract / Independent Consultant
About the Role:
We are seeking board-certified physicians to join our team as External Medical Reviewers. In this role, you will provide independent, evidence-based medical reviews for Fair Hearings and Administrative Hearings. These reviews help determine whether Medicaid services and decisions comply with Medicaid policies, clinical standards, and best practices. This is a remote consulting role, and reviews are assigned based on your specialty, expertise, and availability.
Key Responsibilities
Conduct independent reviews of adverse benefit determinations, medical necessity decisions, provider disputes, investigations, and audit findings issued by Medicaid managed care organizations.
Review case files and supporting documentation and apply relevant Medicaid policies, clinical guidelines, and evidence-based standards.
Provide clear, well-supported written determinations within established turnaround times.
Maintain strict objectivity, confidentiality, and compliance with program requirements, including HIPAA and conflict-of-interest standards.
Follow structured review formats and respond promptly to clarification requests from our internal review coordination team.
Minimum Qualifications:
MD or DO with board certification in a relevant specialty.
Active, unrestricted medical license in Mississippi
At least 3–5 years of recent clinical practice experience.
Strong written communication skills and ability to prepare concise, evidence-supported clinical determinations.
Preferred Qualifications:
Experience with Medicaid, utilization review, prior authorization, peer review, or external medical review.
Familiarity with Mississippi Medicaid medical policies, managed care processes, or state fair hearing requirements.
Multi-state licensure.
Why Join Our Reviewer Panel?
Support an important statewide program improving Medicaid decision accuracy and fairness. Flexible, remote work you can complete around your own clinical schedule. You focus solely on clinical review, while our internal teams handle all case intake, assembly, and administrative functions. Competitive case-based compensation.
...We are currently seeking Production Operators to join the Sparta, WI team! Shift: Night Shift - 12-hours rotating 6pm-6am Production Operator Responsibilities: The Production Operator is responsible for operating equipment in the production area in an efficient...
...Job Description Job Description ABOUT US: Ethos Risk Services is a leading insurance claims investigation and medical management company, specializing in surveillance and fraud detection. At the forefront, we provide accurate data and actionable insights that translate...
Job Description Epic Research Analyst I JOB DESCRIPTION The Epic Research Analyst I will be the principal analyst for the Epic Research module and the Research departments systems that might interface into Epic. They should have a thorough understanding ...
...The Internal Premium Auditor is responsible for conducting premium audits on workers compensation insurance policies to ensure that the insurance premiums our policyholders are paying are correct. To achieve this, you will review payroll records and other business records...
Join the dynamic team at Cox Automotive as a Body Shop Buffer/Finisher Technician and contribute to our mission of delivering top-notch automotive solutions. In this role, you will leverage your skills in auto body finishing to ensure the highest quality of workmanship...