Job Description

Hematologist External Peer Reviewer (EPR) Remote Contractor

Company/Institution:Optum Insight

Location:Remote, MA, USA

Not available

April 8, 2025

April 8-May 8, 2025

External Peer Reviewer contract position (Remote)

Optum develops and licenses industry leading InterQual criteria that have been the gold standard for clinical decision support content and tools for over 40 years. Over 4,300 payers, health care facilities, and provider groups utilize our InterQual criteria to help ensure that they make clinically appropriate medical utilization decisions grounded in evidence-based medicine.

Position summary:

Review InterQual evidence-based criteria specific to your specialty, contained within the following products:

• Level of Care (admission, key interventions, and expected progress): Acute Adult, Acute Pediatric, Acute Rehabilitation, Long-Term Acute Care, Subacute and Skilled Nursing Facility, Home Care, Outpatient Rehabilitation and Chiropractic
• Care Planning: Durable Medical Equipment, Imaging, Molecular Diagnostics, Procedures, Specialty Referral, Specialty Pharmacy, Retrospective Monitoring
• Behavioral Health: Psychiatric conditions, BH Services (e.g., ABA, ECT), Substance use, Dual diagnosis
• Coordinated Care Content: assessments for complex cases

We expect our peer reviewer consultants to be experts in their respective fields. Content reviews are performed with a focus on high-quality medical evidence and standards of care in the field. A peer reviewer is not expected to do additional detailed literature reviews on a given topic, but rather to provide commentary that reflects true clinical practice. Substantiating feedback with medical references to support comments is encouraged and highly valued, especially if you offer differences in opinion from our clinical content.

We would contact you intermittently to review content that is specific to your experience. At that time, we will present the particular project and explain what is required, the estimated time commitment, and expected turnaround time. Based on this information, you determine your availability for the project. There is no obligation on your part to be a peer reviewer for that project, and participation is based solely on your availability and interest.

Key responsibilities include:

• Reviewing criteria to ensure that they are in accordance with the best medical evidence and, where appropriate, standard practice
• Responding to targeted questions about the criteria based on your clinical expertise

Qualifications:

• Active license and/or certification in practice area required
• Practicing clinically at least part-time (not retired or a fellow/resident) required
• Experience in healthcare processes (e.g., utilization, case management) or academics (e.g., faculty, researcher) preferred, not required
• Not a client purchase decision-maker (e.g., not a Medical Director or CIO who influences the decision on which products their organization licenses)
• Proficiency with Microsoft Word and Adobe Acrobat

Additional information:

The time needed to review a packet of clinical materials varies. We determine the deadlines for completion based on the amount of material for review. The time allotted for an individual project may be as little as 1 hour, or rarely as many as 20 hours. However, it is not required that the entire time allotment be used.

Payment is determined on a scale based on clinician credentials (MD/DO, Genetic Counselor, RN, DPT, PharmD, etc). External Peer Reviewers are paid based on the hours spent on review.

Location:

External Peer Reviewer performs work remotely.

About the Employer

Optum Insight
Optum Insight provides technology-enabled services built on the foundation of our health care focus, advanced analytics and cross-industry connections to help customers reduce
costs, better manage risk and quality, and grow revenue. We connect the health care system with trusted services, analytics and platforms that make clinical, administrative and
financial processes easy and efficient for all participants in the health care system.

We apply intelligence, technology and scale to optimize performance and drive results. Improved transaction efficiency, less friction and better decision-making in health care needs advanced solutions that are deeply connected. Optum Insight’s foundational data and technology deliver results in three key areas:

1. Clinical alignment
   Enabling care decisions to be made on evidence-based standards of care right within the workflow of clinicians. By providing insights at the point of care, clinicians use this information as they seek the “next best action” on behalf of their patients.
2. Administrative efficiency
   Streamlining administrative transactions by connecting and enriching data flows and analytics-driven intelligence.
3. Payment simplification
   Improving accuracy and accelerating speed of payment to benefit all stakeholders. Our payment integrity solutions help both payers and providers improve payment accuracy.

How to Apply

If you are interested in the role, please send a copy of your CV to Erin Miller, EPR Recruiter at erin.miller1@optum.com

Contact Information

Erin Miller
1 OPTUM CIRCLE
EDEN PRAIRIE, MN 55344 USA
https://www.optum.com/en/
erin.miller1@optum.com

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