Physician Reviewer (Utilization Management) - 249027

Medix Staffing Solutions, Inc.; Florida; Remoto; USD 265.000 - 275.000; Tempo integral

Benefícios oferecidos por esta vaga

Unlimited vacation

11 paid company holidays

Paid sick time

Wellness reimbursements

Parental leave

401(k) plan participation

Life & disability insurance

Comprehensive medical, dental, and vis

Resumo da vaga

Medix Staffing Solutions, Inc. is seeking a Board-Certified MD/DO to join a fully remote Utilization Management team. You will assess medical appropriateness for inpatient, outpatient, and pharmacy services using evidence-based guidelines and internal policies.

The role requires 6+ years of clinical practice with 1+ year in utilization review. Salary targets are $265,000–$275,000 per year, plus annual bonuses, comprehensive benefits, unlimited vacation, holidays, and wellness programs.

Qualificações

• Board-certified MD/DO required.
• Active medical license in FL or NC, or eligibility for IMLCC.
• 6+ years of clinical practice.
• 1+ year of utilization review experience in a managed care plan.
• Salary target of $265,000–$275,000 per year with bonuses.

Responsabilidades

• Determine medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines and internal policies.
• Provide timely, high-quality medical reviews and clinical determinations.
• Conduct peer-to-peer discussions with treating providers to clarify information and discuss alternative treatments based on medical necessity.
• Document all communication and decision-making in workflow tools clearly.
• Handle escalated cases and maintain compliance with laws and regulations.

Formação

Board-certified MD/DO

Active FL or NC license or IMLCC eligibility

Descrição da vaga

Summary:

We are seeking a collaborative, Board-Certified Physician to join a forward-thinking Utilization Management team. In this fully remote role, you will leverage your clinical acumen to determine the medical appropriateness of inpatient, outpatient, and pharmacy services. This is a fantastic opportunity for a dedicated medical professional to impact patient care on a larger scale by applying evidence-based guidelines within the health insurance industry.

Day to Day:

• Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines and internal policies.
• Provide timely, high-quality medical reviews and clinical determinations that meet stringent quality parameters and turn-around times.
• Conduct professional peer-to-peer discussions with treating providers to clarify clinical information, explain review outcomes, and provide feedback on alternate treatments based on medical necessity criteria.
• Clearly and accurately document all communication and decision-making in workflow tools (ensuring notes are easy to reference and understand).
• Receive and review escalated cases.
• Act as a collaborative team player and maintain compliance with all applicable laws and regulations.

Shift:

• Monday - Friday, 8:00 AM - 5:00 PM (in your local time zone).
• Light call rotation: 1 weekend every 16 weeks.
• 100% Remote (Please note: Candidates cannot reside in AK, DE, HI, LA, MT, NE, ND, OK, WV, or WY).

Qualifications:

• Education & Certification: Board certification as an MD or DO.
• Licensure: Active medical license in FL or NC, and/or an active Interstate Medical Licensure Compact (IMLCC) (or eligible to apply).
• Experience: 6+ years of clinical practice.
• Specialized Experience: 1+ years of utilization review experience in a managed care plan (health care industry).
• Competitive Compensation: Target salary of $265,000 - $275,000 per year (plus annual performance bonuses!)
• Work-Life Balance: Unlimited vacation, 11 paid company holidays, paid sick time, and paid wellness time.
• Health & Wellness: Comprehensive medical, dental, and vision benefits, plus wellness reimbursements.
• Family & Future: Paid parental leave, 401(k) plan participation, and life & disability insurance.