Remote Physician Reviewer-Utilization Management-249027
Now Hiring: Remote Physician Reviewer (Utilization Management) Location: 100% Remote (Work from Home) Compensation: $250,000 – $275,000 / year + 20% Annual Target Bonus Employment Type: Full-Time Are you an experienced physician seeking a high-impact, non-clinical role with true work-life balance? We are seeking a Remote Physician Reviewer to join our clinical team. In this role, you will evaluate the medical necessity and clinical appropriateness of inpatient, outpatient, and pharmacy services, leveraging your medical expertise and evidence-based clinical guidelines to drive high-quality healthcare delivery. Key Responsibilities:
- Conduct clinical reviews of inpatient, outpatient, and pharmacy service requests to determine medical appropriateness.
- Apply established, evidence-based clinical criteria and health plan guidelines to daily utilization reviews.
- Perform peer-to-peer discussions with treating providers as needed to clarify clinical context.
- Ensure timely, consistent, and compliant case determinations within regulatory and accreditation turnaround times.
Required Qualifications:
- Education & Certification: Active Board Certification (ABMS or AOA) as an MD or DO in Family Medicine, Internal Medicine, Emergency Medicine, Neurology, or a related specialty.
- Licensure: Active, unrestricted medical license in Florida (FL) or North Carolina (NC), OR an active IMLCC (Interstate Medical Licensure Compact) license / eligibility to apply.
- Clinical Experience: Minimum 6+ years of direct patient care experience.
- Review Experience: Minimum 1+ years of prior Utilization Review (UR) / Utilization Management (UM) experience within a managed care organization or health plan environment.
- Strong written communication and comfort navigating EHR/care management review platforms.
What We Offer:
- Competitive Base Salary: $250K – $275K annually
- Incentive: Up to 20% annual performance bonus
- 100% Remote Flexibility: Enjoy autonomy and eliminate the commute
- Comprehensive benefits package including medical, dental, vision, 401(k) match, CME allowance, and paid time off.