Remote Physician Reviewer: Utilization Management

Medix Staffing Solutions, Inc.; Texas; Remote; USD 250,000 - 275,000; Full time

Benefits offered by this job

Remote work

Performance bonus

401(k) match

CME allowance

Paid time off

Job summary

Medix Staffing Solutions, Inc. is seeking a Remote Physician Reviewer to join our clinical team.

You will evaluate the medical necessity and clinical appropriateness of inpatient, outpatient, and pharmacy services, leveraging evidence-based guidelines to drive high-quality care. This full-time role requires active Board Certification (MD/DO), Florida or North Carolina licensure (or IMLCC eligibility), and 6+ years of direct patient care with 1+ year UR/UM experience.

Qualifications

• Active Board Certification (ABMS or AOA) as an MD or DO in Family Medicine, Internal Medicine, Emergency Medicine, Neurology, or related specialty.
• Active, unrestricted medical license in Florida or North Carolina, or IMLCC license/eligibility.
• Minimum 6+ years of direct patient care experience.
• Minimum 1+ year UR/UM experience within a managed care environment.
• Strong written communication; comfortable with EHR/care management platforms.

Responsibilities

• Conduct clinical reviews of inpatient, outpatient, and pharmacy service requests to determine medical appropriateness.
• Apply evidence-based criteria and health plan guidelines to utilization reviews.
• Perform peer-to-peer discussions with treating providers when needed.
• Ensure timely, compliant determinations within regulatory turnaround times.

Skills

UR/UM experience

Clinical experience

Written communication

Education

MD or DO

Board Certification (ABMS/AOA)

Job description

Medix Staffing Solutions, Inc. is seeking a Remote Physician Reviewer to join our clinical team.

You will evaluate the medical necessity and clinical appropriateness of inpatient, outpatient, and pharmacy services, leveraging evidence-based guidelines to drive high-quality care. This full-time role requires active Board Certification (MD/DO), Florida or North Carolina licensure (or IMLCC eligibility), and 6+ years of direct patient care with 1+ year UR/UM experience.