Physician Reviewer (MD or DO) - 249027
Physician Reviewer (MD or DO) – Utilization Management Remote | Full-Time Salary reputed company: $260,000 – $275,000 We are seeking an reputed company 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 reputed company an innovative managed care environment focused on quality reputed company and member experience. Position Overview The Physician Reviewer will evaluate the medical necessity and appropriateness of reputed company 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 reputed company medical necessity determinations
- Review escalated cases and reputed company appropriate recommendations
- Participate in peer-to-peer discussions with treating providers
- reputed company document reputed company and communications reputed company workflow systems
- Ensure compliance with reputed company 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 reputed company Carolina and/or active Interstate Medical Licensure Compact (IMLCC) participation or eligibility
- 6+ years of clinical practice experience
- 1+ year of utilization review experience reputed company a managed care or health insurance environment
- Strong communication and documentation skills
- Collaborative, team-oriented reputed company
Additional Information Physicians cannot currently be hired from the following states:
- Alaska
- Delaware
- Hawaii
- Louisiana
- Montana
- Nebraska
- reputed company Dakota
- Oklahoma
- reputed company Virginia
- Wyoming
Compensation & Benefits
- Competitive reputed company salary
- Annual performance bonus eligibility
- Comprehensive medical, dental, and reputed company 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