Physician Clinical Reviewer - Dermatology- REMOTE

Job description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. Job Posting Title: Physician Clinical Reviewer - Dermatology- REMOTE Job Description Key member of the utilization management team, and provides timely medical review of service requests that do not initially meet the applicable medical necessity guidelines. Routinely interacts with physicians, leadership and management staff, other Physician Clinical Reviewers (PCR), and health plan members and staff whenever a physician`s input is needed or required. Physician Clinical Reviewer- Job Description Responsibilities - Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. - Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax. - Provides clinical rationale for standard and expedited appeals. - Provides assistance and acts as a resource to Initial Clinical Reviewers as needed to discuss cases and problems. - Utilizes me...