Medicare Advantage UM Physician - Remote Lead

SCAN; Long Beach (CA); Remote; USD 207,000 - 276,000; Full time

Benefits offered by this job

Mostly Remote

401(k) match

Job summary

SCAN, a California-based nonprofit health organization, seeks a temporary Medicare Advantage UM Physician to provide physician-level determinations for prior authorization, concurrent reviews, and appeals. The role requires California residency familiarity with Medicare Advantage UM practices and NCQA/URAC standards.

The ideal candidate has board certification, a current MD/DO license, and 5+ years of clinical practice with 2–3 years in utilization management, including peer-to-peer discussions

Qualifications

• Graduate of an accredited medical school.
• Current, active medical license (MD/DO).
• Minimum of 5 years of active clinical practice in Internal/Family/Emergency Medicine.
• Minimum 2–3 years in utilization management or managed care.
• Experience with medical necessity criteria (e.g., MCG) and UM frameworks.

Responsibilities

• Perform physician-level medical necessity reviews for prior authorizations and concurrent reviews.
• Render timely determinations per Medicare guidelines and clinical criteria.
• Conduct peer-to-peer discussions with treating providers and document rationale.

Skills

Medical license

UM experience

Clinical review

Peer discussions

Education

Medical degree

Tools

UM platforms

EHRs

Job description

SCAN, a California-based nonprofit health organization, seeks a temporary Medicare Advantage UM Physician to provide physician-level determinations for prior authorization, concurrent reviews, and appeals. The role requires California residency familiarity with Medicare Advantage UM practices and NCQA/URAC standards.

The ideal candidate has board certification, a current MD/DO license, and 5+ years of clinical practice with 2–3 years in utilization management, including peer-to-peer discussions