Utilization Review Physician — Internal Medicine/Neurology

Medix™; United States; Sur place; USD 180 000 - 240 000; Plein temps

Résumé du poste

Medix is seeking a Board-Certified Physician (Internal Medicine or similar background) with an active FL or NC license or IMLC to support utilization management decisions for inpatient, outpatient, and pharmacy services. The ideal candidate brings strong clinical judgment and managed care experience in applying nationally recognized guidelines in a fast-paced, collaborative environment.

The role requires MD or DO with active board certification, multi-state licensure or eligibility, and a

Qualifications

• MD or DO with active Board Certification.
• Active medical license in FL or NC and/or IMLC eligibility.
• Minimum 6 years of clinical practice experience.
• At least 1 year of utilization review experience in a managed care environment.

Responsabilités

• Review and assess medical necessity for inpatient, outpatient, and pharmacy services.
• Apply evidence-based guidelines and medical policy to utilization review determinations.
• Provide peer-to-peer consultations when required.
• Collaborate with care management and clinical teams to support appropriate care delivery.
• Ensure compliance with regulatory, accreditation, and internal quality standards.
• Accurately document decisions within established systems and turnaround times.

Connaissances

Clinical judgment

Managed care experience

Evidence-based guidelines

Peer-to-peer consultations

Formation

MD/DO with active board certification

Description du poste

Medix is seeking a Board-Certified Physician (Internal Medicine or similar background) with an active FL or NC license or IMLC to support utilization management decisions for inpatient, outpatient, and pharmacy services. The ideal candidate brings strong clinical judgment and managed care experience in applying nationally recognized guidelines in a fast-paced, collaborative environment.

The role requires MD or DO with active board certification, multi-state licensure or eligibility, and a