Ophthalmology Utilization Review Physician

ChenMed; Miami (FL); On-site; USD 204,761 - 292,515; Full time

Benefits offered by this job

Comprehensive benefits

Career development

Work-life balance

Job summary

ChenMed is hiring a Physician Reviewer to serve as the primary reviewer for Utilization Management (UM) cases across multiple markets. You will advise other physicians, participate in daily health plan calls, and coordinate patient care with local teams.

This role supports process and quality improvements in a growing Delegated UM area. The position requires an accredited medical degree with an unrestricted license, residency in Internal Medicine or Family Practice, and board certification.

Qualifications

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

Responsibilities

• Primary physician reviewer for Utilization Management (UM) cases.
• Advise other physician reviewers and participate in daily health plan calls.
• Coordinate care for patients with local teams and health plans.
• Participate in Process and Quality improvement for Delegated UM.
• Other duties as assigned by manager.

Skills

Analytical thinking

Deductive reasoning

Problem-solving

Communication skills

Organizational skills

Written and verbal English

Microsoft Office Suite

Education

MD degree

Internal Medicine or Family Practice residency

Board Certification - Ophthalmology

Tools

Microsoft Office Suite

Outlook

Excel

Word

PowerPoint

Job description

ChenMed is hiring a Physician Reviewer to serve as the primary reviewer for Utilization Management (UM) cases across multiple markets. You will advise other physicians, participate in daily health plan calls, and coordinate patient care with local teams.

This role supports process and quality improvements in a growing Delegated UM area. The position requires an accredited medical degree with an unrestricted license, residency in Internal Medicine or Family Practice, and board certification.