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Weekday Physician Peer Review Jobs (NOW HIRING)

Trinity Health

Peer Review Coordinator RN

Fresno, CA

$45.50 - $68.27/hr

This position is responsible for assisting in physician peer review activities and directly supporting the areas of clinical quality and patient safety. The position will collaborate with the Chief ...

Trinityhealth

Peer Review Coordinator RN

Fresno, CA

$45.50 - $68.27/hr

This position is responsible for assisting in physician peer review activities and directly supporting the areas of clinical quality and patient safety. The position will collaborate with the Chief ...

Trinity Health

Peer Review Coordinator RN

Fresno, CA · On-site

$45.50 - $68.27/hr

This position is responsible for assisting in physician peer review activities and directly supporting the areas of clinical quality and patient safety. The position will collaborate with the Chief ...

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Weekday Physician Peer Review information

What is the difference between Weekday Physician Peer Review vs Weekday Medical Reviewer?

AspectWeekday Physician Peer ReviewWeekday Medical Reviewer
CredentialsMedical degree, state medical license, specialty certificationMedical degree, state medical license, often specialty certification
Work EnvironmentHospitals, clinics, insurance companies, medical review organizationsInsurance companies, healthcare organizations, legal settings
Job FocusAssessing clinical documentation, determining medical necessity, quality assuranceEvaluating medical records, ensuring compliance, supporting claims decisions

Weekday Physician Peer Review and Weekday Medical Reviewer roles both involve evaluating medical records and ensuring quality and compliance. However, Physician Peer Review typically emphasizes clinical judgment and peer comparison, while Medical Reviewers focus more on claims, documentation, and regulatory compliance. Both roles require medical credentials and are integral to healthcare quality and insurance processes.

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Weekday Physician Peer Review jobs near you

Physician Peer Reviewer- Dermatologist

Federal Hearings And Appeals

Wilkes Barre, PA • Remote

Contractor

Re-posted 12 days ago

Job description

Physician Peer Reviewer –

Federal Hearings and Appeals Services (FHAS) is a URAC-accredited Independent Medical Review Organization (IRO) with Health Utilization Management (HUM) accreditation. For the past 30 years, FHAS has provided external peer review services to healthcare organizations, government agencies, insurance companies, and legal entities.

FHAS is currently expanding its elite panel of physicians licensed to assist with independent review claims and appeals in any of the following specialties:

Addiction Medicine, Allergy & Immunology, Anesthesiology, Cardiovascular Disease, Child & Adolescent Psychiatry, Chiropractic Medicine, Dentist, Dermatology, Emergency Medicine, Endocrinology, Diabetes, & Metabolism, Family Medicine, Gastroenterology, Internal Medicine, Interventional Cardiology, Interventional Radiology & Diagnostic Radiology, Medical Genetics & Genomics, Medical Oncology, Nephrology, Neurological Surgery, Neurology, Obstetrics and Gynecology, Ophthalmology, Orthopedic Surgery, Pain Medicine, Pathology, Pediatrics, Pediatric Cardiology, Pediatric Critical Care Medicine, Developmental-Behavioral Pediatrics, Pediatric Emergency Medicine, Pediatric Gastroenterology, Pediatric Nephrology, Physical Medicine & Rehabilitation, Plastic Surgery, Psychiatry, Psychology *PhD, Radiation Oncology, Radiology, Rheumatology, Sleep Medicine, Thoracic & Cardiac Surgery, Transplant Hepatology, Undersea & Hyperbaric Medicine

Description

  • Responsible for reviewing medical case files and making medical determinations. Cases may include medical necessity and medical appropriateness, experimental or investigational treatment, administrative or legal issues, or a combination of these categories, which are filed with the Department of Human Services’ Bureau of Hearings and Appeals (BHA).
  • Reviews and analyzes Federal and State laws, regulations, and applicable policy guides
  • Completes and evaluates the review process in a regulatory timeframe.

Work Experience Requirements

  • Successful completion of a Residency or Fellowship Program
  • Must possess a current state license in a state of the United States/recognized in the relevant jurisdictions as a Doctor of Medicine or Doctor of Osteopathic Medicine and if required by contract, licensed in the state in which requests the review.
  • License is unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the medical director or clinical director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer.
  • License is of the type and scope that permits applying clinical judgement in consideration of an individual members clinical needs to render a decision.
  • For either a Doctor of Medicine or Doctor of Osteopathic Medicine, possess the same license or certification as the ordering practitioner.
  • Must hold a current board certification issued by the American Board of Medical Specialties or American Osteopathic Association.
  • 5-years or more post graduate active clinical experience in direct patient care
  • Experience providing direct patient care within the past 3 years, if performing external reviews

Job Type

Contract

Work Location

Remote