Remote Physician Reviewer – Utilization Management

Remote Physician Reviewer – Utilization Management****This Person Needs to sit in PA, NJ, or Delaware****IntePros is seeking a Physician Reviewer to support a leading healthcare organization in a fully remote capacity. This role is responsible for reviewing medical necessity determinations, applying InterQual criteria, and collaborating with clinical and operational teams to ensure high-quality, evidence-based utilization management practices.The ideal candidate will bring a strong Internal Medicine or Family Medicine background, active board certification, and prior experience working directly for a health insurance payer organization.Why This Role Is InterestingFully remote opportunityHigh-impact role supporting clinical decision-making and quality outcomesCollaborative environment with experienced utilization management and care management teamsOpportunity to leverage both clinical expertise and payer-side experienceKey ResponsibilitiesReview inpatient and/or outpatient cases for medical necessity and appropriateness of careApply InterQual criteria and clinical guidelines in utilization management reviewsConduct peer-to-peer discussions when necessaryPartner with care management, case management, and utilization review teamsEnsure compliance with regulatory, accreditation, and payer standardsProvide clinical guidance and support on complex cases and escalationsDocument determinations accurately and thoroughly within internal systemsRequired QualificationsMD or DO with active, unrestricted medical licenseActive Board Certification requiredBackground in Internal Medicine or Family MedicinePrior experience working for a health plan/payer organization strongly preferredStrong understanding of InterQual criteria and utilization management processesExperience performing medical necessity reviews and peer-to-peer consultationsExcellent communication and documentation skillsPreferred QualificationsPrevious experience in managed care or health insurance environmentsMulti-state licensure is a plusExperience with Medicare, Medicaid, and/or commercial payer guidelinesComfortable working independently in a remote environment