Physician Reviewer
The Judge Group Inc
Advisor Medical Expert - Internal Medicine Physician Location: 100% Remote (Continental U.S.)
Schedule: Monday-Friday, Pacific Time business hours
Licensure Required: Active California Medical License Overview Seeking a Board-Certified Internal Medicine or Primary Care Physician to support medical necessity reviews, appeals, utilization management activities, and complex case evaluations within government-sponsored healthcare programs. This fully remote position allows physicians to leverage their clinical expertise outside of direct patient care while influencing quality, access, and appropriate utilization of healthcare services. Responsibilities
Schedule: Monday-Friday, Pacific Time business hours
Licensure Required: Active California Medical License Overview Seeking a Board-Certified Internal Medicine or Primary Care Physician to support medical necessity reviews, appeals, utilization management activities, and complex case evaluations within government-sponsored healthcare programs. This fully remote position allows physicians to leverage their clinical expertise outside of direct patient care while influencing quality, access, and appropriate utilization of healthcare services. Responsibilities
- Review medical necessity determinations, prior authorizations, and appeals
- Conduct peer-to-peer discussions with treating providers
- Evaluate inpatient, outpatient, post-acute, and specialty care cases
- Apply evidence-based medicine and clinical guidelines to decision-making
- Provide clinical consultation to utilization management and care management teams
- Assist with policy development, quality initiatives, and complex case reviews
- MD or DO
- Active, unrestricted California medical license
- Board Certification in Internal Medicine, Family Medicine, or related primary care specialty
- 5+ years of post-residency clinical experience
- Strong background in evidence-based medicine and chronic disease management
- Prior utilization management, payer, medical review, or Medicaid experience preferred
- Fully remote
- No direct patient care
- Influence healthcare quality and utilization decisions
- Collaborative multidisciplinary team environment
- Opportunity to impact Medicaid member care at scale
- Internal Medicine physicians
- Family Medicine physicians
- Hospitalists
- Physicians currently performing utilization review, disability reviews, peer reviews, or health plan medical director work
- Clinicians looking to transition away from full-time patient care while remaining clinically engaged
Vacancy posted 1 day ago
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