Remote Physician Reviewer — Utilization Management

Medix Staffing Solutions, Inc.; North Carolina; A distancia; USD 220.000 - 275.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health coverage

401(k) matching

Paid time off

Life and disability insurance

Descripción de la vacante

Medix Staffing Solutions, Inc. is seeking a Physician Reviewer to join our Utilization Management team. This remote role evaluates medical necessity and clinical appropriateness across inpatient, outpatient, and pharmacy services by reviewing records and applying evidence-based criteria.

You will collaborate with clinical leadership and treating providers to ensure high-quality determinations. Eligible candidates must have FL or NC license (or IMLCC), 6+ years of clinical practice, and 1+ year

Formación

• Current, active Board Certification as an MD or DO.
• Active medical license in Florida (FL) or North Carolina (NC) and/or an Interstate Medical Licensure Compact (IMLCC) license (or eligibility to apply).
• 6+ years of direct clinical practice experience.
• 1+ years of utilization review experience in a managed care or health plan environment.
• Strong written and verbal communication skills; collaborative team player.

Responsabilidades

• Conduct timely and objective clinical reviews to determine medical appropriateness for inpatient, outpatient, and pharmacy services.
• Apply evidence-based guidelines, clinical criteria, and policies with sound clinical judgment.
• Maintain clear, thorough, and compliant clinical documentation within internal systems.
• Adhere to quality standards and turnaround times for clinical reviews and escalations.
• Conduct peer-to-peer discussions with treating providers to discuss details and alternatives.
• Ensure ongoing compliance with applicable healthcare regulatory requirements.

Conocimientos

Clinical judgment

Communication skills

Team collaboration

Educación

MD/DO Board Certification

Descripción del empleo

Medix Staffing Solutions, Inc. is seeking a Physician Reviewer to join our Utilization Management team. This remote role evaluates medical necessity and clinical appropriateness across inpatient, outpatient, and pharmacy services by reviewing records and applying evidence-based criteria.

You will collaborate with clinical leadership and treating providers to ensure high-quality determinations. Eligible candidates must have FL or NC license (or IMLCC), 6+ years of clinical practice, and 1+ year