[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

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