Physician Reviewer - Utilization Management

Salary: USD220000 - USD275000 per year + +Benefits Location: Remote- Must have NC or FL license OR IMLCC Schedule: Full-time | Monday – Friday, 8:00 AM – 5:00 PM (Local Time Zone) Compensation: $220,000 – $275,000 per year (eligible for comprehensive benefits and performance bonus up to 25%) About the Role We are seeking a qualified and detail-oriented Physician Reviewer to join our Utilization Management team. In this role, you will evaluate the medical necessity and clinical appropriateness of inpatient, outpatient, and pharmacy services by reviewing patient records and applying evidence-based clinical criteria. You will collaborate closely with clinical leadership and communicate directly with treating providers to ensure high-quality, patient-centered care determinations. Key Responsibilities Conduct timely and objective clinical reviews to determine medical appropriateness for inpatient, outpatient, and pharmacy services. Apply evidence-based guidelines, clinical criteria, and established policies in conjunction with sound clinical judgment. Maintain clear, thorough, and compliant clinical documentation within internal workflow systems. Adhere strictly to quality standards and required turnaround times for clinical reviews and escalations. Conduct professional peer-to-peer discussions with treating providers to discuss clinical details, review outcomes, and discuss alternative treatment options where appropriate. Ensure ongoing compliance with all applicable healthcare regulatory requirements and standards. Qualifications & Requirements Education & Credentials: Current, active Board Certification as an MD or DO. Licensure: Active medical license in Florida (FL) or North Carolina (NC) , and/or an active Interstate Medical Licensure Compact (IMLCC) license (or eligibility to apply for IMLCC). Clinical Experience: 6+ years of direct clinical practice experience. Utilization Management: 1+ years of utilization review experience within a managed care organization or health plan environment. Strong written and verbal communication skills; collaborative team player. Preferred Qualifications Medical licensure in multiple states (and willingness/ability to obtain additional state licenses as needed). Board Certification in Cardiology , Radiation Oncology , or Neurology . Prior experience with care management or complex case review in the health insurance industry. Eligible Work Locations This is a remote position open to candidates based in most U.S. states. (Note: Candidates residing in AK, DE, HI, LA, MT, NE, ND, OK, WV, or WY are currently not eligible for hire.) Comprehensive health coverage (Medical, Dental, and Vision) Retirement plan with 401(k) matching Paid time off (including holidays, sick time, and parental leave) Life and disability insurance coverage #J-18808-Ljbffr