Physician Reviewer, Utilization Management & Process Lead

ChenMed LLC; United States; On-site; USD 205,000 - 293,000; Full time

Job summary

ChenMed is seeking a Physician Reviewer to lead Utilization Management reviews and collaborate with health plan teams and local staff. You will help develop delegated UM practices and participate in quality improvement initiatives, ensuring care coordination for patients.

Requirements include an MD, unrestricted license, board certification in Internal Medicine or Family Practice, and prior hospital medicine and utilization review experience are preferred.

Qualifications

• Graduate from accredited Medical School with a valid, unrestricted license.
• Board Certification in Internal Medicine or Family Practice.
• Two years’ hospital medicine experience preferred.
• At least one year of utilization review experience preferred.

Responsibilities

• Provide Delegated UM by covering assigned territories and establishing 2–3 cases daily.
• Attend weekly health plan and local calls; participate in PCP/SNF meetings.
• Advise other physician reviewers and support process and quality improvement.
• Other duties as assigned by manager.

Skills

Analytical thinking

Problem solving

Communication skills

Organizational skills

English fluency

Microsoft Office

Education

Medical degree

Board-certified in Internal Medicine or Family Practice

Unrestricted medical license

Hospital medicine experience preferred

Utilization review experience preferred

Tools

Microsoft Office

Job description

ChenMed is seeking a Physician Reviewer to lead Utilization Management reviews and collaborate with health plan teams and local staff. You will help develop delegated UM practices and participate in quality improvement initiatives, ensuring care coordination for patients.

Requirements include an MD, unrestricted license, board certification in Internal Medicine or Family Practice, and prior hospital medicine and utilization review experience are preferred.