Senior Physician Reviewer
MedReview Inc. · United States · US
Utilization Review
Remote
physician
Nurse
Demand78
Career growth70
Healthcare fit84
Remote potential65
Salary band
USD 240k – 250k
5-year outlook
Senior physician reviewer roles typically command competitive physician non-clinical compensation, though exact pay varies by specialty, licensure, payer mix, and location. Demand should remain stable as payers and review organizations manage Medicare Advantage, risk adjustment, and payment integrity.
Clinical license
Required
Applicant reach
narrow
Seniority
senior
Employment type
full-time
Date found
2026-11-09
Intelligence details
Flexible work details
- Side income
- Classified as side-income friendly
- Engagement type
- Contract
- Hours
- Variable hours
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse
- Rate period
- Annual
Why this was classified this way
- Contractor
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth considering for experienced physicians with payer, utilization review, DRG, or appeals backgrounds who want a non-clinical leadership role. It is not suitable for clinicians without prior review or payment integrity experience.
Who should apply
Board-certified MD/DO physicians with utilization review, payment integrity, DRG validation, Medicare Advantage/Medicaid, appeals, or medical director experience. Physician advisors and clinical reviewers seeking supervisory non-clinical roles should consider it.
CV angle
Frame clinical experience around physician-level case review, medical necessity determinations, DRG/clinical validation, CMS compliance, appeals and peer-to-peer communication, and leadership of reviewers. Quantify case volume, audit outcomes, and quality improvements where possible without fabricating payer experience.
Skills to highlight
- Clinical validation
- DRG validation
- Medical necessity review
- Payment integrity
- Appeals and peer-to-peer discussions
- CMS/Medicare Advantage/Medicaid regulations
- Clinical documentation and risk adjustment
- Physician leadership and quality assurance
Role summary
A senior physician reviewer role focused on complex payment integrity, clinical validation, DRG validation, readmission, medical necessity, and appeal reviews for health plans and government programs. The physician also supervises and advises reviewers, nurses, coders, quality teams, and clients on regulatory and clinical determination issues.
We publish our own intelligence summary, never the full job description. Always confirm details with the employer when you apply.