Licensed Physician Reviewer

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Licensed Physician Reviewer based in United States.

As a Licensed Physician Reviewer, you will serve as a primary physician reviewer for Utilization Management (UM) cases, helping ensure patients receive appropriate, coordinated, and medically necessary care. You will support delegated UM activities across multiple markets while collaborating closely with health plan teams, local clinical teams, and other physician reviewers. The role combines clinical judgment with care coordination, stakeholder communication, and process improvement. You will review cases, provide physician-level guidance, and contribute to consistent and effective utilization management practices. You will also participate in quality and process improvement initiatives as the delegated UM function continues to evolve. This is an opportunity to apply your clinical expertise in a collaborative environment focused on improving outcomes and the healthcare experience for older adults.

Accountabilities:

You will provide physician-level oversight of utilization management activities while supporting clinical teams and maintaining strong coordination with health plan and local stakeholders.

• Serve as the primary physician reviewer for assigned Utilization Management cases.
• Provide delegated UM coverage across designated territories and assigned markets.
• Establish and review approximately 2-3 cases per day for each assigned market, with responsibility for up to six markets.
• Participate in health plan and local team calls to support timely case review and care coordination.
• Attend weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings for assigned territories.
• Advise and support other physician reviewers on utilization management cases and clinical considerations.
• Collaborate with health plan teams and local clinical stakeholders to facilitate appropriate patient care.
• Contribute to process and quality improvement initiatives within the developing delegated UM function.
• Help identify opportunities to improve utilization management workflows, coordination, and outcomes.
• Take on additional responsibilities and assignments as directed by management.

Requirements:

The ideal candidate is a licensed physician with strong clinical judgment, communication skills, and the ability to collaborate effectively across health plans, clinical teams, and utilization management stakeholders.

• Active physician licensure appropriate to practice in the United States.
• Clinical experience that supports physician-level utilization management and medical case review.
• Strong clinical judgment and the ability to assess cases and make informed recommendations.
• Excellent verbal and written communication skills.
• Ability to communicate effectively with health plan representatives, local clinical teams, physician reviewers, and other stakeholders.
• Strong organizational skills and the ability to manage multiple cases and markets effectively.
• Ability to work independently while contributing effectively within a collaborative team environment.
• Comfortable participating in recurring clinical meetings, case discussions, and stakeholder calls.
• Strong commitment to patient-centered care and appropriate care coordination.
• Ability to contribute to process improvement and quality initiatives in an evolving healthcare environment.
• Professional judgment, accountability, and adaptability in a fast-paced clinical setting.

Benefits:

• Competitive compensation based on experience, education, geographic location, and other relevant factors.
• Potential eligibility for bonuses or commissions.
• Comprehensive employee benefits.
• Opportunities for career development and advancement.
• Virtual/remote work environment.
• Opportunity to contribute to innovative utilization management and care coordination practices.
• Collaborative environment focused on improving healthcare outcomes for seniors.
• Strong emphasis on work-life balance and professional growth.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?


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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.