Physician Reviewer - Utilization Management

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

Job summary

ChenMed in Miami, Florida is seeking a Physician Reviewer to lead Utilization Management reviews, advise other physician reviewers, and coordinate care with health plans and local teams to support patient outcomes.

The role emphasizes process and quality improvement in delegated UM, demands strong analytical and communication skills, and requires a physician trained in Internal Medicine or Family Practice with board certification.

Qualifications

• Graduate from an accredited medical school with a valid, unrestricted license.
• Completion of Internal Medicine or Family Practice residency.
• Board Certification in Gynecology.
• Two (2) years’ experience in Hospital medicine preferred.
• At least one (1) year of utilization review experience preferred.

Responsibilities

• Provides Delegated UM by covering the specified territories as assigned: establishes 2-3 cases a day for each market covered (up to 6 markets); attends health plan and local calls; participates in weekly PCP and SNF meetings covering territories.
• Advises other physician reviewers.
• Other duties as assigned and modified by manager.

Skills

Analytical reasoning

Deductive reasoning

Problem-solving

Communication skills

Organizational skills

Written and verbal English

MS Office proficiency

Education

Accredited medical school degree

Internal Medicine or Family Practice residency

Board Certification in Gynecology

Hospital medicine experience (2+ years)

Utilization review experience (1+ year)

Tools

Microsoft Office (Outlook, Excel, Word, PowerPoint)

Job description

ChenMed in Miami, Florida is seeking a Physician Reviewer to lead Utilization Management reviews, advise other physician reviewers, and coordinate care with health plans and local teams to support patient outcomes.

The role emphasizes process and quality improvement in delegated UM, demands strong analytical and communication skills, and requires a physician trained in Internal Medicine or Family Practice with board certification.