Prime Therapeutics

Physician Clinical Reviewer -Endocrinology- REMOTE

Home, USA · Vp · Internship

Work authorization required$91k-$154kDetected 91 days ago

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About the role

In addition, Prime retains the right to change or assign other duties to this job Potential pay for this position ranges from $90.87 - $154.33 based on experience and skills.

1 year of work experience in clinical review
Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Familiarity with the principles and procedures of utilization management as practiced in managed care organizations
Medicare Part D experience.
In addition, Prime retains the right to change or assign other duties to this job
Potential pay for this position ranges from $90.87 - $154.33 based on experience and skills.
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

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.
Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner.
Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support.
On a requested basis, may function as Medical Director for select health plans or regions, assuming overall accountability for utilization management while working in conjunction with the VP, Medical Director

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.

Must be eligible to work in the United States without the need for work visa or residency sponsorship.

This listing is sourced directly from Prime Therapeutics's careers page and normalized into a canonical job model.