Remote Medicare Advantage Utilization Physician (Part-Time)

SCAN Health Plan; Long Beach (CA); A distancia; USD 207.000 - 276.000; A tiempo parcial

Ventajas ofrecidas por este puesto de trabajo

401(k) Retirement Plan with employer**

Mostly Remote Work Mode

HQ Long Beach, CA relocation to Cerrit

Company-wide benefits

Descripción de la vacante

SCAN Health Plan in Long Beach, CA, seeks an Agency Temp, Part-time Medicare Advantage Utilization Management Physician to provide physician-level determinations for prior authorizations, concurrent reviews, and appeals. Local California licensure required with NCQA/URAC familiarity.

The role requires at least 5 years of clinical practice in IM/FM/EM and 2–3 years in UM or managed care, plus strong communication and peer-review skills. Mostly remote work with some in-person meetings.

Formación

• Minimum 5 years of active clinical practice in Internal Medicine, Family Medicine, or Emergency Medicine.
• Minimum 2–3 years of utilization management, case management, or managed care experience.
• Working knowledge of MCG and UM regulatory/accreditation frameworks (NCQA, URAC, CMS).
• Experience with appeals and external review processes is a plus.

Responsabilidades

• Perform physician-level medical necessity review of prior authorization requests and reviews.
• Render timely determinations per Medicare guidelines and clinical criteria.
• Conduct peer-to-peer discussions with treating providers and document rationale.
• Serve as reviewer for first-level appeals and participate in peer reviews when needed.
• Maintain availability for urgent/expedited reviews within turnaround windows.

Conocimientos

Analytical skills

Communication skills

Problem solving

Leadership

Educación

MD/DO

Board certification (Internal/Family/Emergency Medicine)

Herramientas

UM platforms

Electronic Health Records

Office software

Descripción del empleo

SCAN Health Plan in Long Beach, CA, seeks an Agency Temp, Part-time Medicare Advantage Utilization Management Physician to provide physician-level determinations for prior authorizations, concurrent reviews, and appeals. Local California licensure required with NCQA/URAC familiarity.

The role requires at least 5 years of clinical practice in IM/FM/EM and 2–3 years in UM or managed care, plus strong communication and peer-review skills. Mostly remote work with some in-person meetings.