Remote Physician Reviewer-Utilization Management-249027

Medix™; Texas; A distancia; USD 250.000 - 275.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Remote work

Performance bonus

401(k) match

CME allowance

Paid time off

Descripción de la vacante

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.

Formación

• 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.

Responsabilidades

• 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.

Conocimientos

UR/UM experience

Clinical experience

Written communication

Educación

MD or DO

Board Certification (ABMS/AOA)

Descripción del empleo

Location: 100% Remote (Work from Home)

Compensation: $250,000 – $275,000 / year + 20% Annual Target Bonus

Employment Type: Full-Time

Are you an experienced physician seeking a high-impact, non-clinical role with true work-life balance?

We are seeking a Remote Physician Reviewer to join our clinical team. In this role, you will evaluate the medical necessity and clinical appropriateness of inpatient, outpatient, and pharmacy services, leveraging your medical expertise and evidence-based clinical guidelines to drive high-quality healthcare delivery.

Key Responsibilities:

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

Required Qualifications:

• Education & Certification: Active Board Certification (ABMS or AOA) as an MD or DO in Family Medicine, Internal Medicine, Emergency Medicine, Neurology, or a related specialty.
• Licensure: Active, unrestricted medical license in Florida (FL) or North Carolina (NC), OR an active IMLCC (Interstate Medical Licensure Compact) license / eligibility to apply.
• Clinical Experience: Minimum 6+ years of direct patient care experience.
• Review Experience: Minimum 1+ years of prior Utilization Review (UR) / Utilization Management (UM) experience within a managed care organization or health plan environment.
• Strong written communication and comfort navigating EHR/care management review platforms.

What We Offer:

• Competitive Base Salary: $250K – $275K annually
• Incentive: Up to 20% annual performance bonus
• 100% Remote Flexibility: Enjoy autonomy and eliminate the commute
• Comprehensive benefits package including medical, dental, vision, 401(k) match, CME allowance, and paid time off.