Senior Physician Reviewer: Utilization Management

ChenMed; Miami (FL); On-site; USD 205,000 - 293,000; Full time

Job summary

ChenMed in Miami seeks a Physician Reviewer to lead delegated Utilization Management cases across multiple markets. You will review cases, coordinate with health plans and local teams, and participate in process and quality improvement for delegated UM.

The role requires a medical degree, active license, residency in Internal Medicine or Family Practice, board certification, and several years in hospital medicine with utilization review experience preferred.

Qualifications

• Graduate from accredited Medical School with a valid, unrestricted license is required.
• Completion of Internal Medicine or Family Practice residency.
• Board Certification in residency area.
• Two (2) years’ experience in Hospital medicine preferred.
• At least one (1) year of utilization review experience preferred.

Responsibilities

• Establish 2-3 cases a day for each market covered (up to 6 markets); attends health plan and local calls.
• Calls in for the weekly PCP and SNF meetings covering the assigned territories.
• Advises other physician reviewers.
• Other duties as assigned and modified by manager.

Skills

Analytical skills

Deductive reasoning

Problem-solving

Communication

Organizational skills

Fluency in English

Attention to detail

Education

Medical degree (MD)

Internal Medicine or Family Practice residency

Board Certification

Hospital medicine experience (2 years) preferred

Utilization review experience (1 year) preferred

Tools

Microsoft Office

Job description

ChenMed in Miami seeks a Physician Reviewer to lead delegated Utilization Management cases across multiple markets. You will review cases, coordinate with health plans and local teams, and participate in process and quality improvement for delegated UM.

The role requires a medical degree, active license, residency in Internal Medicine or Family Practice, board certification, and several years in hospital medicine with utilization review experience preferred.