External Medical Reviewer

2 weeks ago

Jackson, MS, United States QSource Full time
Location: Remote

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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