Job Description

1 week ago Be among the first 25 applicants Job Summary We are seeking a board-certified physician (MD or DO) with clinical experience and knowledge of managed care processes to conduct peer-to-peer reviews, and review appeals and grievances for medical necessity, appropriateness of care, and compliance with health plan policies. The ideal candidate will ensure clinical decisions support evidence-based care and regulatory guidelines. Primary Responsibilities Conduct medical necessity reviews for appeals, grievances, and peer-to-peer consultations. Interpret and apply health plan policies, clinical guidelines, and regulatory requirements. Communicate directly with requesting providers during peer-to-peer discussions. Document clinical determinations and rationale clearly and concisely. Collaborate with internal teams including case managers, utilization review nurses, and compliance staff. Participate in committee meetings, audits, and quality improvement initiatives as needed. Education and Experience MD or DO degree from an accredited medical school. Current, unrestricted medical license in the United States. Board certification in a medical specialty. Minimum of 3-5 years of clinical experience, preferably with experience in managed care or utilization management. Prior experience with appeals, grievances, or peer review is highly desirable. Excellent communication and clinical documentation skills. Knowledge of regulatory standards (CMS, NCQA, URAC, etc.). Seniority level Seniority level Mid-Senior level Employment type Employment type Contract Job function Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Sierra Solutions by 2x Get notified about new Medical Doctor jobs in Arizona, United States . Arizona, United States $225,000.00-$275,000.00 1 week ago Phoenix, AZ $270,000.00-$286,000.00 1 week ago Inpatient Care Management Medical Director - Remote Tucson, AZ $238,000.00-$357,500.00 1 hour ago Arizona, United States $231,900.00-$440,500.00 1 week ago Medical Director - Post-Acute Care Management - Care Transitions - Remote anywhere in US Phoenix, AZ $238,000.00-$357,500.00 1 month ago Telemedicine Physician - Women's Hormone Expert - Remote (MD/DO only) Inpatient Care Management Medical Director - Remote Phoenix, AZ $286,104.00-$397,743.00 9 months ago Telemedicine Physician - Women's Hormone Expert - Remote (MD/DO only) Medical Director Oncology - Remote anywhere in US Phoenix, AZ $238,000.00-$357,500.00 2 weeks ago Phoenix, AZ $83,000.00-$124,500.00 1 week ago Remote Child Behavioral Medical Director - Western Region Arizona, United States $231,900.00-$440,500.00 2 weeks ago Remote Telemedicine Job for Veterinarian (Night / Weekend Shifts) Associate Faculty - Nurse Practitioner Women's Health Management - Part Time Faculty (Virtual) Medical Insurance Customer Service Advisor Senior Medical Science Liaison (Sr. MSL) / Principal Medical Science Liaison (Principal MSL) Oncology - AZ, NM, UT (Open) Senior Medical Science Liaison (Sr. MSL) / Principal Medical Science Liaison (Principal MSL) Oncology - AZ, NM, UT (Open) Licensed Veterinarian (Remote - Independent Contractor) Market CMO, Centerwell Senior Primary Care - Arizona Arizona, United States $270,800.00-$378,800.00 1 week ago Phoenix, AZ $180,000.00-$220,000.00 1 month ago Remote Student Accounts Collection Advisor We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr Sierra Solutions

Job Tags

Contract work, Part time, For contractors, Night shift, Weekend work,

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