Remote Physician Reviewer – Fraud, Waste & Abuse (FWA)

Remote Physician Reviewer – Fraud, Waste & Abuse (FWA) (must reside in Pennsylvania, New Jersey or Delaware)We’re seeking a Physician to support high-impact medical review activities across Fraud, Waste & Abuse (FWA), utilization management, and complex claims.Responsibilities: Review complex utilization management and appeals cases requiring senior clinical judgment Perform FWA medical reviews for large self-funded and union-sponsored health plans Evaluate medical necessity, causality, and appropriateness of care for no-fault and commercial claims Apply evidence-based guidelines to balance quality, safety, and cost containment Conduct physician-to-physician discussions and deliver clear, defensible clinical decisionsRequired Experience: MD or DO with active license Experience in utilization management, peer review, or FWA investigations Strong clinical judgment and ability to communicate complex decisions clearly