Remote Utilization Management Physician — Medical Necessity Expert

HealthPlus Staffing; Daytona Beach (FL); Hybrid; USD 216,000 - 264,000; Full time

Benefits offered by this job

Bonus opportunity

401(k)

Health benefits

Malpractice coverage

PTO + CME

Licenses, fees, travel reimbursement

Job summary

A leading healthcare staffing firm is seeking a Utilization Management Physician for a remote position based in Florida. The ideal candidate will have an MD or DO with an active Florida license and at least 3 years of utilization management experience. Responsibilities include performing medical necessity reviews and conducting peer-to-peer discussions. The role comes with competitive compensation, including a $240,000 base salary plus bonuses and a comprehensive benefits package.

Qualifications

• We require an MD or DO with an active, unrestricted Florida license.
• Minimum of 3+ years of UM Physician experience.
• 3–7 years of clinical experience is mandatory.

Responsibilities

• Review authorizations, claims, and appeals.
• Make medical necessity determinations using MCG/InterQual/CMS criteria.
• Conduct peer-to-peer reviews and support UM staff.
• Participate in provider education as needed.

Skills

Medical necessity reviews

Peer-to-peer reviews

Managed care experience

Clinical determinations

Strong communication skills

Education

MD or DO with active Florida license

Job description

A leading healthcare staffing firm is seeking a Utilization Management Physician for a remote position based in Florida. The ideal candidate will have an MD or DO with an active Florida license and at least 3 years of utilization management experience. Responsibilities include performing medical necessity reviews and conducting peer-to-peer discussions. The role comes with competitive compensation, including a $240,000 base salary plus bonuses and a comprehensive benefits package.