Clinical Reviewers

Join Our National Clinical Reviewer Panel

Federal, state, and private entities rely on IPRO to provide clinical reviews. Due to an increasing number of cases and the introduction of new technology and new treatment modalities, additional well-trained individuals are needed.

IPRO conducts clinical review in the following areas:

Medicare – beneficiary reviews, quality of care reviews, and utilization review;
Medicaid – state case referrals, quality of care reviews, and utilization review;
External Review – review of appeals for care/payment denied by insurance companies.

To be considered for IPRO’s Clinical Reviewer Network, you must:

• Hold a current, non-restricted license in a U.S. state or territory;
• Be certified by a specialty board of the American Board of Medical Specialties;
• Be actively engaged in the practice of medicine and maintain active hospital privileges;
• Have five years of active clinical practice following subspecialty residency.

In addition, proof of academic appointments and publication of your work may be required.

IPRO guarantees its clients the highest possible level of quality, objectivity, and consistency in medical review. Once assigned a case to review, the Clinical Reviewer is expected to render an accurate, impartial decision as to whether the service(s) provided to the patient were medically necessary and appropriate. The rationale for the decision must be documented in writing based on accepted clinical guidelines and issued within the time frame specified. The quality of a reviewer’s work is monitored for all external appeal cases and on a quarterly basis for Medicare and Medicaid.

IPRO is seeking reviewers in the following areas:

If you are interested in becoming a reviewer for IPRO, please e-mail your curriculum vitae to Credentialing@ipro.org.