Remote Physician Reviewer-Utilization Management (MD/DO)-249027

Medix™; United States; On-site; USD 180,000 - 260,000; Full time

Job summary

Medix is seeking a Board-Certified Physician (Internal Medicine or similar) with an active FL or NC medical license and/or Interstate Medical Licensure Compact (IMLC) to support utilization management by reviewing clinical documentation and determining the medical necessity of inpatient, outpatient, and pharmacy services.

The ideal candidate brings strong clinical judgment and managed care experience, applying nationally recognized guidelines in a fast-paced, collaborative environment while

Qualifications

• MD or DO with active Board Certification.
• Active medical license in FL or NC or IMLC eligibility.
• Minimum 6 years of clinical practice experience.
• At least 1 year of utilization review experience in a managed care or health plan environment.

Responsibilities

• Review and assess medical necessity for inpatient, outpatient, and pharmacy services
• Apply evidence-based guidelines and medical policy to utilization review determinations
• Provide peer-to-peer consultations when required
• Collaborate with care management and clinical teams to support appropriate care delivery
• Ensure compliance with regulatory, accreditation, and internal quality standards
• Accurately document decisions within established systems and turnaround times

Education

MD or DO with active Board Certification

Active medical license in FL or NC

IMLC eligibility or participation

Job description

Overview

We are seeking a Board-Certified Physician (Internal Medicine or Similar background preferred with Active FL or NC License and/or IMLC) to support utilization management activities by reviewing clinical documentation and determining the medical appropriateness of inpatient, outpatient, and pharmacy services. This role plays a critical part in ensuring evidence-based, high-quality, and cost-effective care decisions.

The ideal candidate brings strong clinical judgment, experience within managed care, and the ability to apply nationally recognized medical guidelines in a fast-paced, collaborative environment.

Key Responsibilities

• Review and assess medical necessity for inpatient, outpatient, and pharmacy services
• Apply evidence-based guidelines and medical policy to utilization review determinations
• Provide peer-to-peer consultations when required
• Collaborate with care management and clinical teams to support appropriate care delivery
• Ensure compliance with regulatory, accreditation, and internal quality standards
• Accurately document decisions within established systems and turnaround times

Required Qualifications

• MD or DO with active Board Certification
• Active medical license in FL or NC, and/or participation in the Interstate Medical Licensure Compact (IMLC) or eligibility to apply
• Minimum 6 years of clinical practice experience
• At least 1 year of utilization review experience within a managed care or health plan environment

Preferred Qualifications

• Licensure in multiple states
• Board Certification in Internal Medicine or similar field
• Experience with care management within the health insurance industry
• Willingness and ability to obtain additional state licenses as needed

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