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.
...Join Our Growing Team at AdvisaCare Hospice Now Hiring Hospice LPNs in Casa Grande and surrounding areas! AdvisaCare is a thriving and rapidly growing hospice agency, and we need compassionate professionals like you to help us continue making a meaningful impact...
...Precision Landscape is a premier lawn & landscape company in Greenville, SC, dedicated to transforming outdoor spaces into beautiful, functional environments for high end residential properties. We pride ourselves on the Precision Difference: Being Responsive, Reliable...
...Instructional Designer We are seeking an Instructional Designer to join a dynamic engineering and technology organization dedicated to developing scalable, hands-on learning programs for technical professionals and project managers. This role combines creativity...
...Postal Code: 32168 : Supports the administration of the radiation safety program, including compliance with regulatory agencies,... ...calculations for external beam, brachytherapy, and radiopharmaceutical therapy, ensuring accurate treatment planning and delivery....
...Our client, a well-established law firm, is looking to hire an experienced Senior Conflict Analyst for their team. You'd support their Conflict Analysis Team through responding to new business requests, analyzing new hire conflict reports, drafting and tracking receipt...