Remote Physician Reviewer – Utilization Management

Medix Staffing Solutions, Inc.; 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

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.