Remote Physician Reviewer - Utilization Management

Remote Physician Reviewer – Utilization Management ****This Person Needs to sit in PA, NJ, or Delaware**** IntePros is seeking a Physician Reviewer to support a leading healthcare organization in a fully remote capacity. This role is responsible for reviewing medical necessity determinations, applying InterQual criteria, and collaborating with clinical and operational teams to ensure high-quality, evidence-based utilization management practices. The ideal candidate will bring a strong Internal Medicine or Family Medicine background, active board certification, and prior experience working directly for a health insurance payer organization. Why This Role Is Interesting Fully remote opportunity High-impact role supporting clinical decision-making and quality outcomes Collaborative environment with experienced utilization management and care management teams Opportunity to leverage both clinical expertise and payer-side experience Key Responsibilities Review inpatient and/or outpatient cases for medical necessity and appropriateness of care Apply InterQual criteria and clinical guidelines in utilization management reviews Conduct peer-to-peer discussions when necessary Partner with care management, case management, and utilization review teams Ensure compliance with regulatory, accreditation, and payer standards Provide clinical guidance and support on complex cases and escalations Document determinations accurately and thoroughly within internal systems Required Qualifications MD or DO with active, unrestricted medical license Active Board Certification required Background in Internal Medicine or Family Medicine Prior experience working for a health plan/payer organization strongly preferred Strong understanding of InterQual criteria and utilization management processes Experience performing medical necessity reviews and peer-to-peer consultations Excellent communication and documentation skills Preferred Qualifications Previous experience in managed care or health insurance environments Multi-state licensure is a plus Experience with Medicare, Medicaid, and/or commercial payer guidelines Comfortable working independently in a remote environment