Physician Reviewer

Inland Empire Health Plan
California, CA
Job Description
IEHP is seeking a Physician Reviewer to provide clinical support in quality management, utilization management, and care management within the health services department. This remote position involves medical review activities, determining medical necessity, communication with Medical Directors, and supporting healthcare delivery initiatives. The role focuses on ensuring service quality and adhering to regulatory standards.

Requirements

  • Provide medical expertise and clinical judgement.
  • Determine medical necessity for referrals.
  • Perform medical case reviews, including authorizations and grievances.
  • Support medical directors in policy review and care management.
  • Participate in quality improvement and training.

Benefits

  • Competitive salary
  • Telecommute schedule
  • California PERS and Medical Insurance
  • 457(b) Retirement Plan
  • Paid life insurance
  • Pet care insurance
  • CEH certification
]]>