Remote Utilization Management Physician Reviewer

CVS Health; Oregon; Hybrid; USD 207,000 - 253,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

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

The role requires an active MD/DO license in the United States, 1+ year UM experience, and a strong understanding of managed care and CMS guidelines. Competitive pay and comprehensive benefits are offered.

Qualifications

• Active US medical license (MD/DO). NCQA standards familiarity.
• 1+ year UM experience for Medicare/Medicaid preferred.
• Strong understanding of managed care, risk and care coordination.
• Excellent verbal and written communication.

Responsibilities

• Review service requests and document rationale per Oak Street Health policies.
• Apply UM criteria with clinical judgment for determinations.
• Collaborate with Transitional Care and PCP teams to optimize care delivery.
• Maintain knowledge of CMS guidelines to support UM decisions.
• Ensure compliance with payor policies and regulatory requirements.

Skills

UM knowledge

Communication skills

Medical licensure

Medicare/Medicaid

Clinical experience

NCQA standards

US work authorization

Oaky values

Education

MD or DO

Job description

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

The role requires an active MD/DO license in the United States, 1+ year UM experience, and a strong understanding of managed care and CMS guidelines. Competitive pay and comprehensive benefits are offered.