Remote Utilization Management Physician Advisor

Chicago Derm; Illinois; Remote; USD 195,000 - 265,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Retirement plan

Paid time off

Wellness program

Job summary

Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role in the United States. The position requires an MD or DO and 3–5 years of primary care experience, with a focus on Medicare/Medicaid UM services.

Responsibilities include applying UM criteria, coordinating with care teams, and ensuring medically appropriate care. Competitive salary and comprehensive benefits are provided, with regular on-call duties and adherence to regulatory standards.

Qualifications

• At least one year experience providing Utilization Management services to a Medicare and/or Medicaid line of business.
• Excellent verbal and written communication skills.
• A current, clinical, unrestricted license to practice medicine in the United States.
• Graduate of an accredited medical school; M.D. or D.O. degree required.
• 3–5 years of clinical practice in a primary care setting.

Responsibilities

• Review service requests and document the rationale for the decision per Oak Street Health policies and industry standards.
• Use evidence-based criteria and clinical reasoning to make UM determinations.
• Collaborate with care teams to drive efficient and effective care delivery.
• Maintain knowledge of CMS and MCG guidelines for UM decisions.
• Ensure compliance with regulatory and accreditation requirements.

Skills

UM experience

Verbal communication

Written communication

US medical license

Clinical experience

Healthcare policy

Education

MD/DO degree

Medical school graduate

Job description

Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role in the United States. The position requires an MD or DO and 3–5 years of primary care experience, with a focus on Medicare/Medicaid UM services.

Responsibilities include applying UM criteria, coordinating with care teams, and ensuring medically appropriate care. Competitive salary and comprehensive benefits are provided, with regular on-call duties and adherence to regulatory standards.