Remote Physician Reviewer — Utilization Management

IntePros; United States; Remote; USD 190,000 - 220,000; Full time

Job summary

IntePros is seeking a Physician Reviewer to provide remote support for a healthcare organization. The role involves reviewing medical necessity determinations and applying InterQual criteria. Candidates should have an MD or DO, active board certification, and a background in Internal or Family Medicine, preferably with experience in health insurance. This position offers a collaborative environment with opportunities to leverage clinical expertise in utilization management.

Qualifications

• MD or DO with active, unrestricted medical license.
• Active Board Certification required.
• Strong understanding of InterQual criteria and utilization management processes.

Responsibilities

• Review inpatient and/or outpatient cases for medical necessity and appropriateness of care.
• Apply InterQual criteria and clinical guidelines in utilization management reviews.
• Conduct peer-to-peer discussions when necessary.

Skills

Internal Medicine

Family Medicine

Clinical documentation

Utilization management

InterQual criteria

Education

MD or DO with active, unrestricted medical license

Active Board Certification

Job description

IntePros is seeking a Physician Reviewer to provide remote support for a healthcare organization. The role involves reviewing medical necessity determinations and applying InterQual criteria. Candidates should have an MD or DO, active board certification, and a background in Internal or Family Medicine, preferably with experience in health insurance. This position offers a collaborative environment with opportunities to leverage clinical expertise in utilization management.