Medicaid Peer Reviews
Description: At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care. Requirements: We’re growing our network of clinical reviewers and are actively seeking Physicians (MD/DO) who are passionate about quality, accountability, and patient outcomes. As a member of our reviewer panel, you'll play a key role in ensuring the appropriateness, necessity, and quality of care delivered to military members and their families. What You’ll Do
- Conduct independent, remote case reviews evaluating medical necessity, appropriateness, or quality of care.
- Provide evidence-based assessments and written determinations following established clinical guidelines and review criteria.
- Support case types including: Utilization review, Appeals and hearings, Quality of care and standard of care concerns
- Uphold the highest standard of clinical integrity, neutrality, and objectivity.
Qualifications
- Hold an active, unrestricted U.S. license as an MD or DO
- Board certified in your specialty by an ABMS or AOA-recognized board within the State of Maryland or surrounding states
- Minimum of 5 years of clinical experience in your specialty post residency or fellowship
- Currently practicing and seeing patients an average of at least 20 hours per week over the past 30 days
Why This Role
- Fully remote, contract-based (1099)
- Flexible workload – cases assigned based on your availability and specialty
- Impactful work that contributes to high-quality care and oversight
- Compensation is structured on a per-record basis and is contingent upon completion of the patient record review and accompanying report.
- Most cases take 1–3 hours to complete; shorter reviews may take less than 1 hour
- Strong written communication skills and attention to detail
- Ability to review cases objectively and meet turnaround deadlines
- Comfortable working independently in a secure, remote environment
Current High Priority Specialties:
- Dentistry
- Dermatology
- Endocrinology
- Nephrology
- Ophthalmology
- Orthopedics
- Otolaryngology
- Pediatrics
- Pharmacy
- Oncology
Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or [email protected]. Please note that unless you are requesting accommodation, all applications must be submitted through our online application system. Apply tot his job Apply To this Job