Physician Reviewer - Utilization Management

Medix Staffing Solutions, Inc.; North Carolina; Remote; USD 220,000 - 275,000; Full time

Benefits offered by this job

Health coverage

401(k) matching

Paid time off

Life and disability insurance

Job summary

Medix Staffing Solutions, Inc. is seeking a Physician Reviewer to join our Utilization Management team. This remote role evaluates medical necessity and clinical appropriateness across inpatient, outpatient, and pharmacy services by reviewing records and applying evidence-based criteria.

You will collaborate with clinical leadership and treating providers to ensure high-quality determinations. Eligible candidates must have FL or NC license (or IMLCC), 6+ years of clinical practice, and 1+ year

Qualifications

• Current, active Board Certification as an MD or DO.
• Active medical license in Florida (FL) or North Carolina (NC) and/or an Interstate Medical Licensure Compact (IMLCC) license (or eligibility to apply).
• 6+ years of direct clinical practice experience.
• 1+ years of utilization review experience in a managed care or health plan environment.
• Strong written and verbal communication skills; collaborative team player.

Responsibilities

• Conduct timely and objective clinical reviews to determine medical appropriateness for inpatient, outpatient, and pharmacy services.
• Apply evidence-based guidelines, clinical criteria, and policies with sound clinical judgment.
• Maintain clear, thorough, and compliant clinical documentation within internal systems.
• Adhere to quality standards and turnaround times for clinical reviews and escalations.
• Conduct peer-to-peer discussions with treating providers to discuss details and alternatives.
• Ensure ongoing compliance with applicable healthcare regulatory requirements.

Skills

Clinical judgment

Communication skills

Team collaboration

Education

MD/DO Board Certification

Job description

Salary: USD220000 - USD275000 per year + +Benefits

Location: Remote- Must have NC or FL license OR IMLCC

Schedule: Full-time | Monday – Friday, 8:00 AM – 5:00 PM (Local Time Zone)

Compensation: $220,000 – $275,000 per year (eligible for comprehensive benefits and performance bonus up to 25%)

About the Role

We are seeking a qualified and detail-oriented Physician Reviewer to join our Utilization Management team. In this role, you will evaluate the medical necessity and clinical appropriateness of inpatient, outpatient, and pharmacy services by reviewing patient records and applying evidence-based clinical criteria. You will collaborate closely with clinical leadership and communicate directly with treating providers to ensure high-quality, patient-centered care determinations.

Key Responsibilities

• Conduct timely and objective clinical reviews to determine medical appropriateness for inpatient, outpatient, and pharmacy services.
• Apply evidence-based guidelines, clinical criteria, and established policies in conjunction with sound clinical judgment.
• Maintain clear, thorough, and compliant clinical documentation within internal workflow systems.
• Adhere strictly to quality standards and required turnaround times for clinical reviews and escalations.
• Conduct professional peer-to-peer discussions with treating providers to discuss clinical details, review outcomes, and discuss alternative treatment options where appropriate.
• Ensure ongoing compliance with all applicable healthcare regulatory requirements and standards.

Qualifications & Requirements

• Education & Credentials: Current, active Board Certification as an MD or DO.
• Licensure: Active medical license in Florida (FL) or North Carolina (NC) , and/or an active Interstate Medical Licensure Compact (IMLCC) license (or eligibility to apply for IMLCC).
• Clinical Experience: 6+ years of direct clinical practice experience.
• Utilization Management: 1+ years of utilization review experience within a managed care organization or health plan environment.
• Strong written and verbal communication skills; collaborative team player.

Preferred Qualifications

• Medical licensure in multiple states (and willingness/ability to obtain additional state licenses as needed).
• Board Certification in Cardiology , Radiation Oncology , or Neurology .
• Prior experience with care management or complex case review in the health insurance industry.

Eligible Work Locations

This is a remote position open to candidates based in most U.S. states.

(Note: Candidates residing in AK, DE, HI, LA, MT, NE, ND, OK, WV, or WY are currently not eligible for hire.)

• Comprehensive health coverage (Medical, Dental, and Vision)
• Retirement plan with 401(k) matching
• Paid time off (including holidays, sick time, and parental leave)
• Life and disability insurance coverage