Clinical Peer Reviewer - Utilization & Compliance
$122.91k - $188.02kHealthfirst
Healthfirst is seeking a Medical Peer Reviewer based in Pennsylvania to evaluate medical necessity as part of utilization management. The role requires collaboration with various medical departments and demands flexibility in workload. The hiring range is $122,907 to $188,020, depending on experience and qualifications. The successful candidate will have a licensed medical degree, relevant board certification, and must be proficient in time management and critical thinking skills. #J-18808-Ljbffr
Vacancy posted 3 hours ago
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