Utilization Review Physician — Managed Care

Medix™; Town of Florida (NY); On-site; USD 150,000 - 200,000; Full time

Job summary

A technology-driven health insurance company in New York seeks a Recruitment Leader to evaluate clinical appropriateness of services and ensure compliance with standards. The ideal candidate is a board-certified MD or DO with at least 6 years of clinical experience and 1 year in utilization review. Responsibilities include timely medical reviews, clinical determinations, and accurate documentation. Licensure in Florida or North Carolina is a must, with a preference for multiple state licenses. This is a full-time on-site role.

Qualifications

• Minimum of 6 years of clinical practice experience.
• At least 1 year of utilization review experience within managed care or health insurance.

Responsibilities

• Conduct timely medical reviews in alignment with established quality standards.
• Make clinical determinations using evidence-based criteria.
• Document decisions and communications accurately.

Skills

Clinical judgment

Evidence-based criteria application

Documentation accuracy

Education

Board-certified MD or DO

Job description

A technology-driven health insurance company in New York seeks a Recruitment Leader to evaluate clinical appropriateness of services and ensure compliance with standards. The ideal candidate is a board-certified MD or DO with at least 6 years of clinical experience and 1 year in utilization review. Responsibilities include timely medical reviews, clinical determinations, and accurate documentation. Licensure in Florida or North Carolina is a must, with a preference for multiple state licenses. This is a full-time on-site role.