Join our dynamic team where your expertise in Gastroenterology can help shape the future of healthcare! We are seeking a dedicated medical professional to provide expert medical reviews for evaluating the necessity of services that may not meet current utilization review criteria within the United States.

In this engaging role, you will be responsible for reviewing appeals involving denied services based on your recent medical experience and in accordance with established appeal policies. You will also facilitate critical peer-to-peer discussions with referring physicians, helping to clarify clinical information and articulate review outcomes. Your ongoing commitment to professional development is vital, as you’ll need to maintain all necessary credentials and promptly notify eviCore of any changes regarding your medical licenses or board certifications.

As part of our strategic planning initiatives, your insights will contribute to the evaluation and enhancement of our Care Management processes.

We’re looking for a candidate who is either an M.D. or D.O., holding an active medical license in a U.S. state. You must be board certified in Gastroenterology by the American Board of Medical Specialties (ABMS) and have recent hands-on experience in direct patient care (within the last 18 months) along with a minimum of 5 years of clinical practice beyond residency or fellowship. Knowledge of relevant state and federal regulations, URAC, and NCQA standards is a plus, as is familiarity with automated systems and software applications.

Enjoy the benefits of a balanced work life with no nights, weekends, or on-call duties. We offer predictable work schedules and options for both full-time and part-time positions. Compensation includes a salaried package paired with comprehensive benefits designed to support your well-being:

• Flexible scheduling to promote work/life balance, including the option to work remotely
• A generous starting package of 4 weeks Paid Time Off (PTO) per year, plus paid holidays
• One week of Continuing Medical Education (CME)
• Education assistance, tuition reimbursement, and support for professional certifications
• Health, dental, vision, and life insurance, along with an employer-funded Health Savings Account (HSA)
• Paid Volunteer Community Service Days
• Abundant opportunities for career growth, advancement, and promotion
• A 401(k) retirement plan with a company match of 50% on employee contributions up to 6%

At eviCore healthcare, we are deeply committed to enhancing the healthcare landscape while simultaneously enriching the lives of our employees. We value diversity and strive to create an inclusive environment for all. As an Equal Opportunity Employer, we make hiring decisions based on qualifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected characteristic. Please note that applicants must successfully complete a drug test and background investigation.