Remote Utilization Management Physician Reviewer
Ladders
Ladders seeks a Utilization Management Physician Reviewer to join a leader in healthcare. This remote role evaluates service requests, applying evidence-based criteria and collaborating with care teams to ensure appropriate care delivery.
The position emphasizes staying current with CMS/MCG guidelines, compliance with regulatory standards, and contributing to process improvements that strengthen utilization management and patient outcomes across the organization.
#J-18808-Ljbffr- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote workFull timeWork from home
$219k - $286.9k
...Remote Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to...Remote workFull timeFor contractorsLocal areaWork from homeRelocationHome officeWeekend work$219k - $286.9k
...Oscar Health seeks a Physician Reviewer to join the Utilization Management team. You will assess medical appropriateness for inpatient, outpatient, and pharmacy... ...and applying evidence-based guidelines. This remote position, open to candidates nationwide in the United...Remote work- ...Oscar Health is seeking a Physician Reviewer for our Utilization Management team. You will assess medical appropriateness for inpatient, outpatient, and pharmacy... ...services using evidence-based guidelines. This is a remote position open to US residents. Typical hours are 8...Remote workLocal areaWeekend work
- ...Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role. You will apply UM criteria and clinical judgment to determine coverage for inpatient and outpatient services, coordinating with care teams to ensure appropriate...Remote workFull time
$230k
...care one person, one family and one community at a time. Company: Oak Street Health Title: Utilization Management Physician Reviewer Location: Fully Remote Hours: full time, Monday - Friday, 8am -5pm Salary: $230k per year Role Description:...Remote workHourly payFull timeLocal areaMonday to Friday- Oscar Health is seeking a Physician Reviewer for its Utilization Management team. This remote role supports determining medical appropriateness for inpatient, outpatient, and pharmacy services, with a focus on evidence-based guidelines and clear documentation. You will...Remote jobWeekend work
- A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote jobFull timeCasual workMonday to Friday
- ExamWorks is seeking a Board Certified physician (Family Medicine or Internal Medicine) to join as a Utilization Management Physician Reviewer in a full-time, 100% remote role. The schedule is Monday through Friday, 8:30am-5:00pm, with occasional weekend/holiday coverage...Remote jobFull timeMonday to Friday
- Oscar Health seeks a Physician Reviewer to join the Utilization Management team in a remote US-based role. You will determine the medical appropriateness of services and document decisions using evidence-based guidelines and Oscar workflows. Responsibilities include timely...Remote job
$174.07k - $374.92k
For our client, we are seeking a Utilization Management Physician Reviewer to join the team of a leader in the Healthcare space. This remote role is focused on evaluating service requests and making clinically sound utilization management decisions that support appropriate...Remote workVisa sponsorship- ...In this remote contract role, the physician reviews clinical service requests from members and providers, applying clinical judgment and managed care criteria to determine appropriate care. The work... .... Preferred Experience in utilization review, case review, or related...Remote workFull timeContract workWeekend workWeekday work
- ...Acentra Health is seeking a Psychiatrist Physician Reviewer to provide leadership in peer review and utilization activities. The role involves phone consultations with... ...-Service beneficiaries. Position is PRN and remote within Illinois. The ideal candidate is...Remote workRelief
- ...Independent Contractor (1099) Remote Opportunity Required State... ...Founded in 1983, Medical Review Institute of America (MRIoA... ...specializing in technology-driven utilization management and clinical medical review... ...seeking Board-Certified physicians in Orthopedic Surgery to...Remote workFor contractorsFlexible hours
- ...ezURs is seeking board-certified Pain Management Physicians for fully remote Physician Consultant positions. As a URAC accredited Independent Review Organization, our physicians perform utilization reviews, disability, and peer reviews across multiple lines of business...Remote workFor contractors
- ...nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are... ...Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role... ...portal and streamlined case management. Full onboarding and ongoing...Remote workPrice workExtra incomeFor contractorsFlexible hours
- A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday - Friday work week. Responsibilities include reviewing medical records,...Remote workFor contractorsMonday to FridayFlexible hours
- ...Sentara Health Plans is hiring a Clinical Claims Reviewer/RN for a remote role. This full-time position involves utilization management and post-payment review across various care settings, with RN licensure and coding credentials under consideration. The role offers...Remote workFull time
$52 - $56 per hour
...apply the same medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$56/hr based on experience... ...and appeals end to end: intake, investigation, clinical review, decision and notification Apply medical necessity...Remote workContract workAfternoon shift$35 - $40 per hour
...Sagility LLC, a leader in healthcare transformation, seeks an RN Utilization Management Reviewer for a fully remote role. You will perform timely clinical decision reviews for services requiring prior authorization across various clinical areas, applying criteria like...Remote workHourly pay- ...Cook Children's Health Care System is seeking a Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer to coordinate the efficient utilization of health care resources for CCHP members and ensure timely, quality care throughout the continuum...Remote work
- About MMRO Managed Medical Review Organization (MMRO) is a nationally recognized... ...of experienced practicing physicians. MMRO is committed to... ...questions. Reviews are conducted remotely and do not require direct... ...established turnaround times. Utilize MMRO review templates and...Remote workFull timeFor contractorsFlexible hours
$204.76k - $292.52k
...we need great people to join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties... ...site, please click HERE Current Contingent Worker please see job aid HERE to apply #LI-RemoteRemote workHourly payFull timeWork at officeLocal area- ...Sentara Health Plans is seeking an RN Clinician for remote utilization management and claims review. You will perform pre/post payment reviews, authorizations, and post-payment inquiries in a compliant manner with NCQA, CMS, DMAS guidelines. Requires a BSN and 3 years...Remote work
- ...ChenMed is seeking a Physician Reviewer to serve as the primary reviewer for Utilization Management (UM) cases across the assigned markets. You will advise other physician reviewers and participate in daily health plan calls to coordinate care for patients. This role...Local area
- ...System team, and The Power of Every One. Job Title Utilization Management RN Reviewer Location Cleveland Facility Remote Location Department Utilization And Quality... ...denials appeals process, clinical team interaction, Physician Adviser interaction and special projects. A...Remote workFull timeWork at officeShift workWeekend work
- Coastal Care Services, Inc. is seeking an LPN licensed Utilization Management Nurse Reviewer for a work-from-home opportunity serving the Miami, FL... ...Equipment, reviews medical necessity, collaborates with physicians, patients and families to assure cost-effective, high-quality...Remote jobWeekday work
- ...Dane Street is an Independent Review Organization and a national provider of Utilization Review services (among other offerings... ...) and we are expanding our physician panel resulting in... ...services. Specialties PM&R/Pain Management The average time spent on most...Remote workExtra incomeContract work
- ...join our dynamic team of expert reviewers! In this role, you will have the opportunity to utilize your medical expertise to conduct... ...clients. We are looking for Physicians in the following area: ~ Internal Medicine/Pain Management Be a part of a team that values...Remote workFor contractors
$248.5k - $373k
...internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led... ...'ll enjoy the flexibility to work remotely * from anywhere within the U.S. as... ...determination processesParticipates in case review and medical necessity...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home
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