Secondary Physician Reviewer Job at Greenlife Healthcare Staffing, Raceland, KY

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  • Greenlife Healthcare Staffing
  • Raceland, KY

Job Description

Secondary Physician Reviewer - Russell, KY (#R10154)

Location:  Russell, KY
Employment Type:  Full-time
Hourly Rate:  $115.00 - $120.00/hour

About Greenlife Healthcare Staffing:

Greenlife Healthcare Staffing is a leading nationwide recruitment agency dedicated to connecting healthcare professionals with top-tier opportunities. We partner with hospitals, clinics, nursing homes, multi-specialty groups, and private practices to match talented individuals with roles that align with their skills and career goals.

Position Overview:

Lead utilization management efforts by conducting critical second-level medical necessity reviews. Ensure optimal resource allocation and compliance with CMS/payer guidelines while driving cost-effective, high-quality patient care across diverse healthcare settings.

Key Responsibilities:

  • Conduct second-level medical necessity reviews for concurrent and retrospective cases.
  • Determine admission status, length of stay, and appropriate level of care.
  • Review readmission cases for clinical relevance within a 30-day window.
  • Provide expert guidance for:
    • Medicare, Medicaid, and Commercial payers
    • First-level review escalations
    • Coding denial appeals
    • Government and Managed Medicare appeals
  • Produce and present monthly reports and ongoing analysis of review outcomes.
  • Ensure HIPAA-compliant communications and secure data handling.

Requirements

Qualifications:

  • Education: MD/DO from an accredited institution
  • Licensure: Active medical license (good standing)
  • Experience:
    • At least 5 years’ experience in clinical review, hospital medicine, or utilization management.
    • Expertise in federal and state payer guidelines, including CMS.
    • Strong understanding of inpatient, observation, and outpatient criteria (e.g., InterQual, MCG).
  • Technical Skills: 
    • Experience with electronic documentation systems and secure communications platforms.
    • Peer-level (physician) reviewers for a range of review/appeal tasks.
  • Soft Skills:
    • Analytical decision-making
    • HIPAA compliance

Benefits

Why Join Us?

  • Competitive Compensation: On-Site: Monday - Friday, 24/7 electronic correspondence availability (including weekends and holidays) 8:00 a.m. - 5:00 p.m. - $115.00 per hour Phone support from 7:30 a.m. - 11:59 p.m. - $115.00 + $5.00 per hour
  • Comprehensive Benefits: Premium compensation
  • Professional Growth:
    • Master federal/state payer regulations (CMS, Medicaid, Commercial) 
    • Influence system-wide resource utilization strategies

Job Tags

Hourly pay, Full time, Private practice, Monday to Friday,

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