Physician Reviewer - Utilization Management (Remote) - 249027

Salary Range: $260,000 – $275,000 annually Call Rotation: One weekend every 16 weeks Position Type: Full-time | Remote | Non-clinical We are seeking a Board-Certified Physician to join a Utilization Management team in a fully remote, non-clinical role. This position focuses on reviewing clinical documentation and determining the medical appropriateness of inpatient, outpatient, and pharmacy services using evidence-based guidelines. This is an excellent opportunity for physicians with managed care or utilization review experience who are interested in a stable, remote role with standard business hours. Responsibilities Review and assess medical necessity for inpatient, outpatient, and pharmacy services Apply evidence-based guidelines and medical policies to utilization review determinations Conduct peer-to-peer discussions with treating providers when needed Collaborate with care management and clinical teams to support appropriate care delivery Ensure compliance with regulatory, accreditation, and internal quality standards Accurately document decisions within established systems and turnaround time requirements Required Qualifications MD or DO with active board certification Active medical license in Florida or North Carolina, and/or participation in or eligibility for the Interstate Medical Licensure Compact (IMLCC) Minimum of 6 years of clinical practice experience At least 1 year of utilization review experience within a managed care or health plan environment Preferred Qualifications Board certification in Cardiology, Radiation Oncology, or Neurology Experience with care management within the health insurance industry Willingness and ability to obtain additional state licenses as needed This organization is an equal opportunity employer and values a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification. #J-18808-Ljbffr Medix™