Remote Physician Reviewer

Recruitment Leader at Medix™ – Expert in Staffing APP’s and Physicians. The organization is a technology‑driven health insurance company built on a full‑stack platform focused on member‑centered care. Founded in 2012, it delivers a supportive, accessible, and clinically grounded insurance experience. About the Role You will evaluate the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence‑based guidelines. Key Responsibilities Conduct timely medical reviews in alignment with established quality standards. Make clinical determinations using evidence‑based criteria, internal guidelines, and sound clinical judgment. Clearly and accurately document decisions and communications in workflow systems using appropriate templates. Ensure documentation is understandable for members. Meet required turnaround times for reviews. Review escalated cases as needed. Participate in peer‑to‑peer discussions with treating providers to clarify clinical information and explain review outcomes, including alternative treatment options when appropriate. Maintain compliance with all applicable laws and regulations. Perform other duties as assigned. Call rotation: one weekend every 16 weeks. You will report to the Associate Medical Director, Utilization Management. Requirements Board‑certified MD or DO. Licensed in Florida or North Carolina, and/or eligible for or active participation in 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 insurance setting. License Must Have FL License NC License IMLC Preferred Qualifications Licensure in multiple states. Board certification in Cardiology, Radiation Oncology, or Neurology. Experience with care management in the health insurance industry. Willingness to obtain additional state licenses as needed, with employer support. Equal Opportunity & Accessibility This organization is an Equal Opportunity Employer committed to fostering an inclusive and supportive environment where individuals can bring their authentic selves to work. Applicants are نمایید solely on qualifications. Reasonable accommodations are available for candidates who need them during the application process. #J-18808-Ljbffr