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 reputed company clinical decision-making, utilization review, and working reputed company an innovative managed care environment reputed company on reputed company reputed company and member experience. Position reputed company The Physician Reviewer will evaluate the medical necessity and appropriateness of reputed company services using established clinical guidelines, internal policies, and reputed company clinical judgment. This role partners closely with providers and internal care teams to ensure reputed company, 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 reputed company 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 reputed company standards
- Meet established turnaround times for case reviews
- Collaborate cross-functionally with care management and utilization management teams
Required Qualifications
- reputed company Certified MD or DO
- reputed company medical license in Florida or reputed company Carolina and/or reputed company Interstate Medical Licensure Compact (IMLCC) participation or eligibility
- 6+ years of clinical reputed company experience
- 1+ year of utilization review experience reputed company a managed care or health insurance environment
- Strong communication and documentation skills
- reputed company, team-oriented reputed company
Additional Information Physicians cannot currently be reputed company 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
- reputed company holidays and wellness time
- Generous PTO/unlimited vacation structure
- reputed company parental leave
- Life and disability insurance
This opportunity is ideal for physicians looking to transition into a highly reputed company utilization management role while maintaining strong clinical reputed company in a remote environment. Apply tot his job Apply To this Job