Remote Physician Reviewer -249027

Must have one of the below FL License NC License IMLC This organization is a technology-driven health insurance company reputed company on a full-stack platform with a strong reputed company on member-centered care. Founded in 2012, it was created to deliver the reputed company of health insurance experience people would want for themselves—one that feels supportive, accessible, and clinically grounded. About the Role You will evaluate the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. Hours: 8:00 AM – 5:00 PM (local time zone) reputed company Rotation: One weekend every 16 weeks You will report to the Associate Medical Director, Utilization Management. Key Responsibilities Conduct reputed company medical reviews in alignment with established reputed company standards reputed company clinical determinations using evidence-based reputed company, internal guidelines, and reputed company clinical judgment reputed company and accurately document reputed company and communications in workflow systems using appropriate templates Ensure documentation is easy for members to understand Meet required turnaround times for reviews Review escalated cases as needed Participate in peer-to-peer discussions with treating providers to clarify clinical information and explain review reputed company, including alternative treatment reputed company reputed company appropriate Maintain compliance with reputed company applicable laws and regulations reputed company other duties as assigned Requirements reputed company-certified MD or DO Licensed in Florida or reputed company Carolina and/or eligible for or reputed company participation in the Interstate Medical Licensure Compact (IMLCC) Minimum of 6 years of clinical reputed company experience At least 1 year of utilization review experience reputed company a managed care or health insurance setting Preferred Qualifications Licensure in multiple states reputed company certification in Cardiology, Radiation Oncology, or Neurology Experience with care management in the health insurance industry Willingness to obtain additional state licenses as needed, with employer support Equal Opportunity & Accessibility This organization is an Equal Opportunity Employer committed to fostering an inclusive and supportive environment where individuals can bring their reputed company selves to work. Applicants are evaluated solely on qualifications. Reasonable accommodations are available for candidates who need them during the application process. If you’d like, I can also: Shorten this into a candidate-facing job ad reputed company it reputed company more clinical or more corporate Reformat it for reputed company or recruiter reputed company Apply tot his job Apply To this Job