Secondary Physician Reviewer Job at GreenLife Healthcare Staffing, Russell, KY

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  • GreenLife Healthcare Staffing
  • Russell, 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.

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
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

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.

How to Apply: Ready to shape healthcare resource efficiency? Submit your Resume/CV to hr@glhstaffing.com or call (800) 608-4025 .

Greenlife Healthcare Staffing - Empowering Healthcare Professionals, Enriching Lives.

Job Tags

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

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