Physician Reviewer (MD or DO) - 249027

Physician Reviewer (MD or DO) – Utilization ManagementRemote | Full-TimeSalary Range: $260,000 – $275,000We are seeking an experienced Physician Reviewer to join a growing Utilization Management team supporting evidence-based medical review activities across inpatient, outpatient, and pharmacy services.This is an excellent opportunity for a physician who enjoys collaborative clinical decision-making, utilization review, and working within an innovative managed care environment focused on quality outcomes and member experience.Position OverviewThe Physician Reviewer will evaluate the medical necessity and appropriateness of healthcare services using established clinical guidelines, internal policies, and sound clinical judgment. This role partners closely with providers and internal care teams to ensure timely, accurate, and compliant review determinations.ScheduleMonday – Friday8:00 AM – 5:00 PM in your local time zoneWeekend call rotation: approximately 1 weekend every 16 weeksKey ResponsibilitiesConduct timely utilization reviews for inpatient, outpatient, and pharmacy servicesApply evidence-based guidelines and clinical expertise to make medical necessity determinationsReview escalated cases and provide appropriate recommendationsParticipate in peer-to-peer discussions with treating providersClearly document decisions and communications within workflow systemsEnsure compliance with all applicable regulations and quality standardsMeet established turnaround times for case reviewsCollaborate cross-functionally with care management and utilization management teamsRequired QualificationsBoard Certified MD or DOActive medical license in Florida or North Carolina and/or active Interstate Medical Licensure Compact (IMLCC) participation or eligibility6+ years of clinical practice experience1+ year of utilization review experience within a managed care or health insurance environmentStrong communication and documentation skillsCollaborative, team-oriented mindsetAdditional InformationPhysicians cannot currently be hired from the following states:AlaskaDelawareHawaiiLouisianaMontanaNebraskaNorth DakotaOklahomaWest VirginiaWyomingCompensation & BenefitsCompetitive base salaryAnnual performance bonus eligibilityComprehensive medical, dental, and vision coverage401(k) with company participationPaid holidays and wellness timeGenerous PTO/unlimited vacation structurePaid parental leaveLife and disability insuranceThis opportunity is ideal for physicians looking to transition into a highly collaborative utilization management role while maintaining strong clinical impact in a remote environment.