Remote Clinical Utilization Review Physician

Medix™; United States; On-site; USD 180,000 - 220,000; Full time

Job summary

A technology-driven health insurance organization is seeking a board-certified MD or DO for a medical review role. The candidate will evaluate the appropriateness of inpatient and outpatient services, ensuring compliance with established standards. Preferred qualifications include licensure in multiple states and experience in the health insurance industry. Responsibilities involve conducting timely reviews, making evidence-based decisions, and participating in peer discussions. This role requires minimum 6 years clinical experience and at least 1 year in utilization review.

Qualifications

• Minimum of 6 years of clinical practice experience.
• At least 1 year of utilization review experience.
• Licensed or eligible for licensure in multiple states.

Responsibilities

• Conduct timely medical reviews in alignment with established quality standards.
• Make clinical determinations using evidence-based criteria.
• Document decisions accurately in workflow systems.
• Participate in peer-to-peer discussions with treating providers.
• Maintain compliance with applicable laws and regulations.

Skills

Clinical judgment

Evidence-based decision-making

Documentation skills

Compliance with laws and regulations

Education

Board-certified MD or DO

Licensed in Florida or North Carolina

Job description

A technology-driven health insurance organization is seeking a board-certified MD or DO for a medical review role. The candidate will evaluate the appropriateness of inpatient and outpatient services, ensuring compliance with established standards. Preferred qualifications include licensure in multiple states and experience in the health insurance industry. Responsibilities involve conducting timely reviews, making evidence-based decisions, and participating in peer discussions. This role requires minimum 6 years clinical experience and at least 1 year in utilization review.