Lead Physician Reviewer, Utilization Management

ChenMed; Miami (FL); On-site; USD 205,000 - 293,000; Full time

Job summary

ChenMed is seeking a Physician Reviewer to serve as the primary reviewer for Utilization Management (UM) cases across the assigned markets. You will advise other physician reviewers and participate in daily health plan calls to coordinate care for patients.

This role supports ChenMed’s mission to transform healthcare for seniors through quality improvement and collaboration with local teams. A medical degree with internship/residency in Internal Medicine or Family Practice and board

Qualifications

• Graduate from accredited Medical School with a valid, unrestricted license is required.
• Completion of Internal Medicine or Family Practice residency.
• Board Certification in Infectious Disease.
• Two (2) years’ experience in Hospital medicine preferred.
• At least one (1) year of utilization review experience preferred.

Responsibilities

• Provides Delegated UM coverage across assigned territories.
• Establish 2-3 cases daily per market; attend health plan and local calls.
• Advises other physician reviewers.
• Other duties as assigned and modified by manager.

Skills

Excellent analytical and deductive

Good judgement and problem-solving

Professional communication skills

Strong organizational skills

English fluency

MS Office proficiency

Education

Medical School degree

Internal Medicine or Family Practice residency

Board Certification in Infectious Disease

Hospital medicine experience

Utilization review experience

Job description

ChenMed is seeking a Physician Reviewer to serve as the primary reviewer for Utilization Management (UM) cases across the assigned markets. You will advise other physician reviewers and participate in daily health plan calls to coordinate care for patients.

This role supports ChenMed’s mission to transform healthcare for seniors through quality improvement and collaboration with local teams. A medical degree with internship/residency in Internal Medicine or Family Practice and board