Remote Utilization Management Physician Reviewer

Oak Street Health, part of CVS Health; Chicago (IL); Remote; USD 210,000 - 250,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings

Wellness programs

Job summary

Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role. You will apply UM criteria and clinical judgment to determine coverage for inpatient and outpatient services, coordinating with care teams to ensure appropriate care.

The position requires an MD/DO, 1+ year UM experience with Medicare/Medicaid, and knowledge of CMS/MCG guidelines. Benefits are competitive and focused on quality care.

Qualifications

• At least one year of UM experience with Medicare/Medicaid.
• Current, unrestricted medical license in the United States.
• MD or DO degree from an accredited medical school.
• 3–5 years of clinical practice in a primary care setting.
• Strong understanding of managed care and care coordination.

Responsibilities

• Review service requests and document rationale for UM determinations.
• Apply evidence-based UM criteria with clinical judgment.
• Collaborate with Transitional Care and PCP teams to improve care delivery.
• Maintain knowledge of CMS and MCG guidelines for UM decisions.
• Ensure regulatory and accreditation requirements are met.
• Participate in committees or work-groups to advance UM efforts.

Skills

Communication skills

US work authorization

MD/DO license

Clinical primary care experience

Cultural responsiveness

Detail orientation

Education

MD or DO degree

Job description

Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role. You will apply UM criteria and clinical judgment to determine coverage for inpatient and outpatient services, coordinating with care teams to ensure appropriate care.

The position requires an MD/DO, 1+ year UM experience with Medicare/Medicaid, and knowledge of CMS/MCG guidelines. Benefits are competitive and focused on quality care.