New Mexico-Licensed Physician Reviewers (M.D., D.O.)-Multiple Specialties

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Requirements:

• Must hold an active New Mexico medical license.
• Required specialties include Endocrinology, Gastroenterology, Dermatology, Neurology, Psychiatry, Rheumatology, Pediatrics, and Ophthalmology.
• Maintains proper credentialing and adheres to state licensing requirements.
• Must attend all required orientation and training.

Responsibilities:

• Reviews all medical records to address client inquiries utilizing specific and recognized criteria.
• Ensures clarity and adequacy of rationale in determinations with supporting documentation.
• Critiques and utilizes current guidelines and peer-reviewed literature for objective decision-making.
• Provides criteria used in reviews alongside reports in a timely manner.
• Meets deadlines by returning cases on or before due dates.
• Makes mandated telephone calls as required by state or client.
• Maintains required licenses and certifications.
• Attends mandatory orientation and training sessions.
• Handles other duties including quality assurance issues and audits.