Senior Physician Reviewer, Utilization Management & Quality

ChenMed; United States; Remote; USD 205,000 - 293,000; Full time

Job summary

ChenMed is seeking a Physician Reviewer to lead Utilization Management (UM) cases, advise other reviewers, and support delegated UM across multiple markets. This role involves coordinating with health plans and local teams to ensure efficient care coordination for patients and participating in process and quality improvement initiatives.

The ideal candidate holds an MD with Internal Medicine or Family Practice training, board certification, and experience in hospital medicine and utilization

Qualifications

• Graduate from accredited Medical School with a valid, unrestricted license.
• 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

• Provides Delegated UM by covering the specified territories as assigned (2–3 cases/day across up to 6 markets).
• Attends health plan and local calls; participates in PCP and SNF meetings for assigned territories.

Skills

Analytical thinking

Deductive reasoning

Communication skills

Organizational skills

English fluency

MS Office

Education

Medical School degree

Internal Medicine or Family Practice residency

Board Certification

Hospital medicine experience (2+)

Utilization review experience (1+)

Tools

MS Office

Job description

ChenMed is seeking a Physician Reviewer to lead Utilization Management (UM) cases, advise other reviewers, and support delegated UM across multiple markets. This role involves coordinating with health plans and local teams to ensure efficient care coordination for patients and participating in process and quality improvement initiatives.

The ideal candidate holds an MD with Internal Medicine or Family Practice training, board certification, and experience in hospital medicine and utilization