Remote Physician Reviewer — Utilization & Quality Oversight

tango; Phoenix (AZ); On-site; USD 180,000 - 240,000; Full time

Job summary

tango is seeking a Physician Reviewer to join our remote, full-time team. You will perform real-time utilization management case reviews, apply evidence-based guidelines, and conduct peer-to-peer discussions with payers and physicians to determine medical necessity for home health services.

You will collaborate with provider relations and clinical management to support quality improvement, ensure regulatory compliance, and educate clinicians across the network while working from a flexible,

Qualifications

• MD or DO licensed in good standing in the state(s) where UM reviews are conducted.
• Board certification through ABMS is preferred (Internal Medicine, geriatrics, Family Medicine, etc.).
• Active practicing physician with 10+ years of clinical experience.

Responsibilities

• Perform real-time utilization management case reviews.
• Conduct peer-to-peer discussions with payer medical directors and providers.
• Apply evidence-based guidelines to determine medical necessity for services.
• Identify and document areas of inappropriate utilization of resources.
• Ensure compliance with regulatory and accreditation requirements.

Skills

Utilization management

Peer-to-peer discussions

Regulatory compliance

Education

MD/DO

ABMS board certification

Tools

Milliman Care Guidelines

InterQual

Job description

tango is seeking a Physician Reviewer to join our remote, full-time team. You will perform real-time utilization management case reviews, apply evidence-based guidelines, and conduct peer-to-peer discussions with payers and physicians to determine medical necessity for home health services.

You will collaborate with provider relations and clinical management to support quality improvement, ensure regulatory compliance, and educate clinicians across the network while working from a flexible,