Physician Reviewer Jobs in USA with Visa Sponsorship
Physician Reviewer roles attract strong H-1B and O-1 visa sponsorship because they require an MD or DO and active U.S. medical licensure. Most openings are with health plans, utilization management firms, and telehealth companies that regularly sponsor international physicians. For detailed occupation requirements, see the O*NET profile.
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Get Access To All JobsINTRODUCTION
Ready to help us transform healthcare? Bring your true colors to blue.
ROLE
The Physician Reviewer is responsible for evaluating pre & post-service clinical service requests made by BCBSMA members and providers. The Physician Reviewer uses their clinical judgment in conjunction with BCBSMA criteria to adjudicate these requests, engaging in peer-to-peer outreach with treating providers, as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas of BCBSMA. The physician reviewer will exercise sound clinical judgment in looking for opportunities to manage and optimize members’ clinical situations and health outcomes, with a view toward creative problem solving and in anticipation of possible future clinical problems for the member.
This position is eligible for the Flex persona.
Key Responsibilities:
-
Apply BCBS Criteria and guidelines to case reviews of BCBS members in order to determine if coverage of the requested service is appropriate, as determined by plan benefit design, plan riders, and medical necessity criteria. In making coverage decisions regarding level of care, benefit and medical policy, evaluate individual case information received from members, ordering and treating providers, case managers, and office staff.
-
Assess available clinical documentation and identify clinically relevant missing information upon which a coverage determination depends, making reasonable efforts to obtain relevant information via UM clinical reviewers, peer-to-peer outreach, and/or direct provider EMR access, as available.
-
Document critical activities relating to coverage decisions and final determinations regarding coverage in the BCBSMA utilization management system (MHK), so that decisions and medical reasoning related to the decision are clear and useful to PRU customers (members, consumers, providers, case managers, brokers, and other users of MHK).
-
Complete coverage determinations in a timely fashion in order to meet regulatory, accreditation, and unit productivity guidelines.
-
Work as part of the PRU team, sharing ideas, communicating best practices, identifying opportunities for unit effectiveness, and creating a positive work environment.
-
Develop and continuously improve expertise and understanding of BCBS medical policy, products, computer systems, PRU operating policies, and Health and Medical Management policies.
-
Practice anticipatory case management for members whose cases come for review, identifying opportunities for improved care coordination and placing internal BCBSMA case management referrals, as clinically appropriate.
-
Participate in the PRU’s appeal process of service and claims denials.
-
Participate in the development of PRU’s policies and procedures.
-
Actively participate in all unit continuous quality improvement activities.
-
Perform additional tasks as assigned by the leadership of the PRU.
-
Adhere to NCQA, URAC, MCRA, FEP, Medicare and other applicable regulatory and accreditation standards.
MINIMUM QUALIFICATIONS
-
MD or DO degree with an active specialty board certification.
-
Current and valid, unrestricted license to practice medicine in the state of Massachusetts.
-
Active clinical practice in order to process appeals.
-
Experience in Utilization Management in a managed-care or risk contract environment (committee work, large group practice, or peer review).
-
Experience with basic computer programs, including but not limited to Windows OS, MS Word and MS Outlook.
-
Leadership abilities, including skills to motivate and develop staff.
-
Excellent collaboration, negotiation, and verbal/written communication skills.
-
Ability to manage conflict effectively over the phone with a demonstrated ability to establish a professional environment conducive to maintaining psychological safety and respectful discourse.
-
Effective provider and case management communication skills, with demonstrated active listening skills.
-
Able to adequately perform all responsibilities of the role in a mixed in-person/virtual (“Mobile” or “eWorker”) work setting.
EDUCATION/RELEVANT EXPERIENCE/SKILLS
High school degree or equivalent required unless otherwise noted above.
LOCATION
Location Hingham
Time Type
Full time
SALARY RANGE
- Salary Range: $230,850.00 - $282,150.00
The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.
This job is also eligible for variable pay.
We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
WHY Blue Cross Blue Shield of MA?
We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.
As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.
INTRODUCTION
Ready to help us transform healthcare? Bring your true colors to blue.
ROLE
The Physician Reviewer is responsible for evaluating pre & post-service clinical service requests made by BCBSMA members and providers. The Physician Reviewer uses their clinical judgment in conjunction with BCBSMA criteria to adjudicate these requests, engaging in peer-to-peer outreach with treating providers, as appropriate. At the request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides clinical leadership in other areas of BCBSMA. The physician reviewer will exercise sound clinical judgment in looking for opportunities to manage and optimize members’ clinical situations and health outcomes, with a view toward creative problem solving and in anticipation of possible future clinical problems for the member.
This position is eligible for the Flex persona.
Key Responsibilities:
-
Apply BCBS Criteria and guidelines to case reviews of BCBS members in order to determine if coverage of the requested service is appropriate, as determined by plan benefit design, plan riders, and medical necessity criteria. In making coverage decisions regarding level of care, benefit and medical policy, evaluate individual case information received from members, ordering and treating providers, case managers, and office staff.
-
Assess available clinical documentation and identify clinically relevant missing information upon which a coverage determination depends, making reasonable efforts to obtain relevant information via UM clinical reviewers, peer-to-peer outreach, and/or direct provider EMR access, as available.
-
Document critical activities relating to coverage decisions and final determinations regarding coverage in the BCBSMA utilization management system (MHK), so that decisions and medical reasoning related to the decision are clear and useful to PRU customers (members, consumers, providers, case managers, brokers, and other users of MHK).
-
Complete coverage determinations in a timely fashion in order to meet regulatory, accreditation, and unit productivity guidelines.
-
Work as part of the PRU team, sharing ideas, communicating best practices, identifying opportunities for unit effectiveness, and creating a positive work environment.
-
Develop and continuously improve expertise and understanding of BCBS medical policy, products, computer systems, PRU operating policies, and Health and Medical Management policies.
-
Practice anticipatory case management for members whose cases come for review, identifying opportunities for improved care coordination and placing internal BCBSMA case management referrals, as clinically appropriate.
-
Participate in the PRU’s appeal process of service and claims denials.
-
Participate in the development of PRU’s policies and procedures.
-
Actively participate in all unit continuous quality improvement activities.
-
Perform additional tasks as assigned by the leadership of the PRU.
-
Adhere to NCQA, URAC, MCRA, FEP, Medicare and other applicable regulatory and accreditation standards.
MINIMUM QUALIFICATIONS
-
MD or DO degree with an active specialty board certification.
-
Current and valid, unrestricted license to practice medicine in the state of Massachusetts.
-
Active clinical practice in order to process appeals.
-
Experience in Utilization Management in a managed-care or risk contract environment (committee work, large group practice, or peer review).
-
Experience with basic computer programs, including but not limited to Windows OS, MS Word and MS Outlook.
-
Leadership abilities, including skills to motivate and develop staff.
-
Excellent collaboration, negotiation, and verbal/written communication skills.
-
Ability to manage conflict effectively over the phone with a demonstrated ability to establish a professional environment conducive to maintaining psychological safety and respectful discourse.
-
Effective provider and case management communication skills, with demonstrated active listening skills.
-
Able to adequately perform all responsibilities of the role in a mixed in-person/virtual (“Mobile” or “eWorker”) work setting.
EDUCATION/RELEVANT EXPERIENCE/SKILLS
High school degree or equivalent required unless otherwise noted above.
LOCATION
Location Hingham
Time Type
Full time
SALARY RANGE
- Salary Range: $230,850.00 - $282,150.00
The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.
This job is also eligible for variable pay.
We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
WHY Blue Cross Blue Shield of MA?
We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.
As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.
How to Get Visa Sponsorship in Physician Reviewer
Confirm your medical license transfers
U.S. state medical licenses are required for most Physician Reviewer positions. Verify your license is active and recognized in the state where the employer operates before applying, as sponsorship won't proceed without it.
Highlight board certification in your application
Board certification in internal medicine, emergency medicine, or a relevant specialty strengthens both your candidacy and the H-1B specialty occupation argument. Employers and USCIS both view it as evidence of the role's professional complexity.
Understand the H-1B cap and timing
Most Physician Reviewer roles are cap-subject H-1B positions. Registration opens in March for an October 1 start date. If you miss the lottery, ask employers about cap-exempt affiliations with hospitals or research institutions.
Consider the O-1 if you have notable credentials
Physicians with published research, leadership roles in medical societies, or recognized clinical expertise may qualify for the O-1A visa. It bypasses the H-1B lottery entirely and has no annual cap, making it worth exploring with an immigration attorney.
Physician Reviewer jobs are hiring across the US. Find yours.
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Get Access To All JobsFrequently Asked Questions
Do Physician Reviewer jobs typically qualify for H-1B sponsorship?
Yes. Physician Reviewer positions generally qualify as H-1B specialty occupations because they require an MD or DO degree and clinical judgment in a defined medical specialty. USCIS has historically approved H-1B petitions for this role, particularly when the job description emphasizes clinical review criteria and medical necessity determinations. Approval rates are strong when the employer documents the degree requirement clearly in the Labor Condition Application.
Which visa types are most common for Physician Reviewers seeking sponsorship?
The H-1B is the most common path, but Physician Reviewers have several options. International medical graduates who completed U.S. residencies on J-1 visas may need a waiver first. Physicians with strong academic or research profiles sometimes qualify for the O-1A, which has no lottery. A small number of Canadian and Mexican physicians may be eligible for TN status under the physician category, which requires a job offer and proof of licensure.
Is a U.S. medical license required for sponsorship, or can employers sponsor before I'm licensed?
Most employers won't initiate sponsorship until you hold an active state medical license, since the role legally requires it. Some larger health systems will begin the H-1B process while a license application is pending, but USCIS approval and start date will typically be conditioned on licensure being granted before you begin work. Don't assume a pending license is sufficient without confirming this with the employer.
Where can I find Physician Reviewer jobs that offer visa sponsorship?
Migrate Mate is the recommended platform for finding Physician Reviewer positions that explicitly offer visa sponsorship. General job boards surface a high volume of roles that don't sponsor, which wastes time during a period when timelines matter. Filtering by visa type on Migrate Mate narrows results to employers who have confirmed they'll support H-1B or other nonimmigrant petitions for this role.
Can a Physician Reviewer role support a green card application?
Yes. Physician Reviewers can pursue permanent residence through the EB-2 category, and in some cases EB-1B if they have exceptional research credentials. Employers in health plans or managed care typically support PERM labor certification if you've been employed for a qualifying period. Physicians who worked in a federally designated shortage area under a J-1 waiver may also qualify for the EB-2 National Interest Waiver without requiring employer sponsorship.
What is the prevailing wage requirement for sponsored Physician Reviewer jobs?
U.S. employers sponsoring a visa must pay at least the prevailing wage, which is what workers in the same role, area, and experience level typically earn. The Department of Labor sets this rate to make sure companies aren't hiring foreign workers simply because they'd accept lower pay than a U.S. worker. It varies by job title, location, and experience. You can look up current prevailing wage rates for any occupation and location using the OFLC Wage Search page.
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