Physician (Medicaid Peer Review)

TL;DR

Physician (Medicaid Peer Review): Conducting independent medical necessity and quality of care reviews for military health programs with an accent on clinical integrity and evidence-based assessment. Focus on evaluating utilization, appeals, and standard of care concerns to ensure high-quality patient outcomes.

Location: Must hold an active, unrestricted U.S. license and be board certified in Maryland or surrounding states

Company

hirify.global is a data-centric healthcare technology company focused on transforming health outcomes through value-based solutions and clinical expertise.

What you will do

• Conduct independent remote case reviews evaluating medical necessity and quality of care.
• Provide evidence-based assessments and written determinations based on clinical guidelines.
• Support utilization reviews, appeals, and hearings.
• Maintain clinical integrity, neutrality, and objectivity in all determinations.

Requirements

• Active, unrestricted U.S. license as an MD or DO required.
• Board certification by an ABMS or AOA-recognized board in Maryland or surrounding states required.
• Minimum of 5 years of clinical experience post-residency or fellowship required.
• Must be currently practicing and seeing patients at least 20 hours per week.
• Strong written communication skills and attention to detail.

Culture & Benefits

• Fully remote, contract-based (1099) role.
• Flexible workload with cases assigned based on availability.
• Impactful work contributing to healthcare oversight and quality.
• Compensation structured on a per-record basis.