Physician Reviewer (249027)

Physician – Utilization Management (MD/DO)

Location:

Remote (U.S.)

Schedule:

Monday–Friday, 8:00 AM–5:00 PM (local time zone)

Call Rotation:

1 weekend every 16 weeks

Salary:

$260,000–$275,000

About the Role

We are seeking a Board-Certified Physician (MD/DO) to support Utilization Management (UM) activities by determining the medical appropriateness of inpatient, outpatient, and pharmacy services.

In this role, you will apply evidence-based clinical guidelines and medical policy to ensure appropriate, high-quality, and cost-effective care across the healthcare continuum.

Key Responsibilities

• Review clinical documentation to determine

medical necessity

for inpatient, outpatient, and pharmacy services

• Apply

evidence-based guidelines and internal medical policies

to utilization management decisions

• Collaborate with

care management teams and clinical staff

to support appropriate care delivery

• Ensure decisions align with

regulatory, accreditation, and organizational standards

• Participate in

peer-to-peer discussions

as needed to support utilization determinations

Required Qualifications

• MD or DO

from an accredited medical school

• Board Certified Physician
• Active medical license

in

Florida or North Carolina

, or eligibility through the

Interstate Medical Licensure Compact (IMLCC)

• 5\+ years of clinical practice experience
• 1\+ year of Utilization Review/Utilization Management experience

in a

managed care or health plan environment

Why Join Us?

• Predictable weekday schedule

with minimal call rotation

• Opportunity to

impact patient care at a system level

• Remote work environment

with strong collaboration across clinical teams

• Work within a

physician-led organization focused on quality and efficiency

Hiring Restrictions

At this time, we are

unable to hire candidates residing in the following states

:

Alaska • Delaware • Hawaii • Louisiana • Montana • Nebraska • North Dakota • Oklahoma • West Virginia • Wyoming

Equal Opportunity Employer

We are an

Equal Opportunity Employer

committed to fostering a diverse and inclusive workplace where all employees feel valued and supported.