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Remote Physician Reviewer Fraud, Waste & Abuse (Fwa)

Job

Intepros

Remote

Full-Time

Posted 2 weeks ago (Updated 2 weeks ago) • Actively hiring

Expires 6/30/2026

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Job Description

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 judgmentPerform FWA medical reviews for large self-funded and union-sponsored health plansEvaluate medical necessity, causality, and appropriateness of care for no-fault and commercial claimsApply evidence-based guidelines to balance quality, safety, and cost containmentConduct physician-to-physician discussions and deliver clear, defensible clinical decisions
Required Experience:
MD or DO with active licenseExperience in utilization management, peer review, or FWA investigationsStrong clinical judgment and ability to communicate complex decisions clearly