Qsource
Provide independent, evidence-based medical reviews for Fair Hearings and Administrative Hearings to determine compliance with Medicaid policies, clinical standards, and best practices. Conduct reviews of adverse benefit determinations, medical necessity decisions, provider disputes, investigations, and audit findings issued by Medicaid managed care organizations.
Key Responsibilities
- • Conduct independent reviews of adverse benefit determinations, medical necessity decisions, provider disputes, investigations, and audit findings issued by Medicaid managed care organizations.
- • Review case files and supporting documentation and apply relevant Medicaid policies, clinical guidelines, and evidence-based standards.
- • Provide clear, well-supported written determinations within established turnaround times.
- • Maintain strict objectivity, confidentiality, and compliance with program requirements, including HIPAA and conflict-of-interest standards.
- • Follow structured review formats and respond promptly to clarification requests from our internal review coordination team.
Required
- • MD or DO with board certification in a relevant specialty.
- • Active, unrestricted medical license in Mississippi
- • At least 3–5 years of recent clinical practice experience.
- • Strong written communication skills and ability to prepare concise, evidence-supported clinical determinations.
Preferred
- • Experience with Medicaid, utilization review, prior authorization, peer review, or external medical review.
- • Familiarity with Mississippi Medicaid medical policies, managed care processes, or state fair hearing requirements.
- • Multi-state licensure.
Benefits & Perks
- • Support an important statewide program improving Medicaid decision accuracy and fairness.
- • Flexible, remote work you can complete around your own clinical schedule.
- • You focus solely on clinical review, while our internal teams handle all case intake, assembly, and administrative functions.
- • Competitive case-based compensation.
Company Overview
Industry: Healthcare Technology
Company Size: 500-1,000 employees
Founded: 2015
Headquarters: San Francisco, CA
Company Links
Key Contacts
Contact information not available
About the Company
Leading healthcare technology company focused on improving patient outcomes through innovative digital solutions. We're transforming the way healthcare is delivered with cutting-edge technology and data-driven insights. Our platform serves over 10,000 healthcare professionals and has processed millions of patient interactions.
Recent News & Updates
Status: Contract / Independent Consultant
About The Role
We are seeking board-certified physicians to join our team as External Medical Reviewers. In this role, you will provide independent, evidence-based medical reviews for Fair Hearings and Administrative Hearings. These reviews help determine whether Medicaid services and decisions comply with Medicaid policies, clinical standards, and best practices. This is a remote consulting role, and reviews are assigned based on your specialty, expertise, and availability.
Key Responsibilities
Conduct independent reviews of adverse benefit determinations, medical necessity decisions, provider disputes, investigations, and audit findings issued by Medicaid managed care organizations.
Review case files and supporting documentation and apply relevant Medicaid policies, clinical guidelines, and evidence-based standards.
Provide clear, well-supported written determinations within established turnaround times.
Maintain strict objectivity, confidentiality, and compliance with program requirements, including HIPAA and conflict-of-interest standards.
Follow structured review formats and respond promptly to clarification requests from our internal review coordination team.
Minimum Qualifications
MD or DO with board certification in a relevant specialty.
Active, unrestricted medical license in Mississippi
At least 3–5 years of recent clinical practice experience.
Strong written communication skills and ability to prepare concise, evidence-supported clinical determinations.
Preferred Qualifications
Experience with Medicaid, utilization review, prior authorization, peer review, or external medical review.
Familiarity with Mississippi Medicaid medical policies, managed care processes, or state fair hearing requirements.
Multi-state licensure.
Why Join Our Reviewer Panel?
Support an important statewide program improving Medicaid decision accuracy and fairness. Flexible, remote work you can complete around your own clinical schedule. You focus solely on clinical review, while our internal teams handle all case intake, assembly, and administrative functions. Competitive case-based compensation.
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