Physician Reviewer – Utilization Management (Remote) - 260253

Medix™; United States; Remote; USD 211,000 - 275,000; Full time

Benefits offered by this job

Health coverage

401(k)

Paid time off

Holidays & sick leave

License renewal support

Job summary

Medix Staffing Solutions, Inc. seeks a board-certified physician to join our utilization management team as a Physician Reviewer.

This remote role evaluates inpatient, outpatient, and pharmacy requests for medical necessity with evidence-based guidelines, ensuring timely, high-quality care. The role requires MD/DO with active board certification and licensure in FL or NC or IMLCC eligibility, 6+ years of clinical practice, and 1+ year in utilization review within managed care.

Qualifications

• MD or DO with active board certification.
• Active licensure in FL or NC; IMLCC eligibility.
• Minimum 6+ years direct patient care experience.
• 1+ year in utilization review within a managed care setting.

Responsibilities

• Conduct medical reviews and render coverage determinations using evidence-based guidelines.
• Lead provider peer-to-peer discussions to discuss clinical rationales and alternatives.
• Document determinations clearly in review templates with defensible rationale.
• Meet established quality standards and regulatory turnaround times.
• Collaborate with medical director and teams on compliance updates.

Skills

Clinical decision making

Evidence-based review

Interdisciplinary collaboration

HIPAA compliance

Documentation proficiency

Education

Medical Degree (MD or DO) with active Board Certification

Job description

Location:

100% Remote (Must reside in an eligible U.S. state; must be Licensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC.)

Schedule:

Monday – Friday | 8:00 AM – 5:00 PM (Local Time Zone)

On-call rotation: 1 weekend every 16 weeks

Compensation:

$211,200 – $275,000 / year (Commensurate with experience and qualifications)

Position Summary

We are seeking a board-certified physician to join a collaborative clinical operations team as a Physician Reviewer in Utilization Management. In this role, you will evaluate inpatient, outpatient, and pharmacy service requests for medical necessity, ensuring patients receive timely, high-quality, and evidence-based care while maintaining strict clinical and regulatory standards.

Key Responsibilities

• Clinical Coverage Determinations: Conduct comprehensive, timely medical reviews and render coverage determinations on initial requests, escalations, and appeals using evidence-based guidelines and clinical acumen.
• Provider Peer-to-Peer Discussions: Lead professional, collaborative peer-to-peer discussions with treating providers to discuss clinical rationales, clarify treatment details, and suggest evidence-based alternatives when applicable.
• Clear Documentation: Document all clinical determinations and decision rationales accurately in review templates, ensuring communications are clear, defensible, and accessible to members and clinical teams alike.
• Quality & Turnaround Compliance: Consistently meet established quality standards and regulatory turnaround times for all assigned clinical reviews.
• Continuous Improvement: Collaborate with the medical director and interdisciplinary teams to ensure adherence to compliance laws, regulations, and clinical criteria updates.

Required Qualifications

• Education & Credentials: Medical Degree (MD or DO) with active Board Certification.
• Licensure:
• Active, unrestricted medical license in Florida or North Carolina
• Active Interstate Medical Licensure Compact (IMLCC) qualification / immediate eligibility to apply.
• Clinical Experience: Minimum of 6+ years of direct patient care / clinical practice.
• Managed Care Experience: Minimum of 1+ years of utilization review experience within a managed care organization (MCO), health plan, or health insurance setting.
• Workspace & Technical: Secure, private, HIPAA-compliant home office with high-speed internet.

Preferred Qualifications

• Board Certification in Cardiology, Medical/Radiation Oncology, or Neurology.
• Active medical licenses in multiple states (or willingness to obtain additional state licensure with employer sponsorship).
• Prior background in care management or health plan quality review.

Location Requirements

• This position is open to remote candidates across most of the continental United States MUST be licensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC.
• Comprehensive health coverage (Medical, Dental, and Vision)
• 401(k) retirement savings plan
• Generous paid time off / vacation policy, plus paid company holidays and sick leave
• Life and disability insurance
• Employer-sponsored license renewals and multi-state credentialing support