Physician Reviewer (MD or DO) - 249027
Physician Reviewer (MD or DO) – Utilization Management Remote | Full-Time Salary Range: $260,000 – $275,000 We are seeking an experienced Physician Reviewer to join a growing Utilization Management team supporting evidence-based medical review activities across inpatient, outpatient, and pharmacy services. This is an excellent opportunity for a physician who enjoys collaborative clinical decision-making, utilization review, and working within an innovative managed care environment focused on quality outcomes and member experience. Position Overview The Physician Reviewer will evaluate the medical necessity and appropriateness of healthcare services using established clinical guidelines, internal policies, and sound clinical judgment. This role partners closely with providers and internal care teams to ensure timely, accurate, and compliant review determinations. Schedule
- Monday – Friday
- 8:00 AM – 5:00 PM in your local time zone
- Weekend call rotation: approximately 1 weekend every 16 weeks
Key Responsibilities
- Conduct timely utilization reviews for inpatient, outpatient, and pharmacy services
- Apply evidence-based guidelines and clinical expertise to make medical necessity determinations
- Review escalated cases and provide appropriate recommendations
- Participate in peer-to-peer discussions with treating providers
- Clearly document decisions and communications within workflow systems
- Ensure compliance with all applicable regulations and quality standards
- Meet established turnaround times for case reviews
- Collaborate cross-functionally with care management and utilization management teams
Required Qualifications
- Board Certified MD or DO
- Active medical license in Florida or North Carolina and/or active Interstate Medical Licensure Compact (IMLCC) participation or eligibility
- 6+ years of clinical practice experience
- 1+ year of utilization review experience within a managed care or health insurance environment
- Strong communication and documentation skills
- Collaborative, team-oriented mindset
Additional Information Physicians cannot currently be hired from the following states:
- Alaska
- Delaware
- Hawaii
- Louisiana
- Montana
- Nebraska
- North Dakota
- Oklahoma
- West Virginia
- Wyoming
Compensation & Benefits
- Competitive base salary
- Annual performance bonus eligibility
- Comprehensive medical, dental, and vision coverage
- 401(k) with company participation
- Paid holidays and wellness time
- Generous PTO/unlimited vacation structure
- Paid parental leave
- Life and disability insurance
This opportunity is ideal for physicians looking to transition into a highly collaborative utilization management role while maintaining strong clinical impact in a remote environment. Apply tot his job Apply To this Job