Medical Reviewer

Physician Advisor and Clinical Denial Location: Guadalajara (On-Site, FTE) Compensation: Competitive remuneration (approx. $25,840 MXN/month), annual performance-based bonus, and standard industry benefits. Key Responsibilities: Review admissions and service requests (prospective, concurrent, and retrospective) to determine medical necessity and compliance with reimbursement policies. Collaborate with physicians and healthcare teams to ensure appropriate documentation, case justification, and discharge planning. Identify and address inappropriate admissions or denials; notify healthcare teams of reimbursement-impacting decisions. Act as liaison between the Physician Advisor and attending physicians to support accurate documentation and clinical appeals. Support denial resolution processes and ensure all communications with payors are properly documented and escalated when needed. Communicate efficiently with third-party payors, physicians, patients/families, and internal stakeholders. Participate in utilization and peer review meetings, providing insight on clinical documentation, treatment duration, and justification. Required Competencies and Skills: Excellent written and spoken English Strong personal and professional ethics Self-motivated and committed to high performance Client-focused mindset and service excellence orientation Doctorate in Medicine (M.D. or equivalent) Experience in clinical review, case management, or utilization review is a plus.

Creado: Jue, 01 de Ene de 1970