Physician Clinical Reviewer - Urology- REMOTE

Prime Therapeutics (Prime) is a purpose‑driven PBM seeking a Physician Clinical Reviewer – Urology (remote). This key member of the utilization management team provides timely medical review of service requests that do not initially meet medical necessity guidelines. The role involves routine interaction with physicians, leadership, and other PCR staff to ensure compliant, evidence‑based decision making. Responsibilities Review cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. Discuss determinations with ordering providers or physicians within the regulatory time frame by phone or fax. Provide clinical rationale for standard and expedited appeals. Assist and act as a resource to Initial Clinical Reviewers with case discussion and problem resolution. Utilize medical/clinical review guidelines and parameters to assure consistency in the review process. Record all communications with medical office staff and/or physicians in a timely and accurate manner. Participate in ongoing inter‑rater reliability training and testing. Assist the Medical Director/VP in research activities, guideline interpretation, and system support. On request, review appeal cases and/or attend hearings for utilization management decisions. On request, may function as Medical Director for select health plans or regions, assuming overall accountability for utilization management in cooperation with the VP/Medical Director. Perform other duties as assigned. Education & Experience Education Level: DO, MBBS, MD. Experience: 5+ years in clinical review or related health services. Must be eligible to work in the United States without the need for work visa or residency sponsorship. Physical Demands Remain stationary 50% of the time. Move or traverse as required. Operate a computer and other office productivity equipment continuously. Communicate information and ideas clearly. Lift or move up to 10 pounds and occasionally up to 25 pounds. Compensation Potential pay ranges from $90.87 - $154.33 per hour based on experience and skills. Benefits Benefits, incentives, and additional compensation details are available on the Benefits Page ( Links and resources are provided on the company website. Equal Opportunity Prime Therapeutics LLCis proud to be an equal‑opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law. We welcome candidates with arrest or conviction records and those requiring reasonable accommodations. Prime Therapeutics is a tobacco‑free workplace employer. Contact Applicants needing a reasonable accommodation may contact Human Resources at View phone number on click.appcast.io or email View email address on click.appcast.io. #J-18808-Ljbffr