Physician Clinical Reviewer - Rheumatology- REMOTE

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 - Rheumatology- REMOTE

Job Description

Job Description

The Physician Clinical Reviewer is a 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. This role 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.

Responsibilities

Physician Clinical Reviewer - Job Description Responsibilities

• Reviews cases in which clinical determin...