Remote Physician Reviewer-Utilization Management-249027

Physician Reviewer – Utilization Management (Remote)-Full Time • *reputed company** We are seeking a reputed company-Certified Physician to support utilization management activities by reviewing clinical documentation and determining the medical appropriateness of inpatient, outpatient, and pharmacy services. This role plays a critical part in ensuring evidence-based, high-reputed company, and cost-effective care reputed company. The ideal candidate brings strong clinical judgment, experience reputed company managed care, and the ability to apply nationally recognized medical guidelines in a fast-paced, reputed company environment. Key Responsibilities • Review and assess medical necessity for inpatient, outpatient, and pharmacy services • Apply evidence-based guidelines and medical policy to utilization review determinations • reputed company peer-to-peer consultations reputed company required • Collaborate with care management and clinical teams to support appropriate care delivery • Ensure compliance with regulatory, accreditation, and internal reputed company standards • Accurately document reputed company reputed company established systems and turnaround times Required Qualifications • MD or DO with reputed company reputed company Certification • reputed company medical license in • *FL or NC** , and/or participation in the • *Interstate Medical Licensure Compact (IMLC)** or eligibility to apply • Minimum • *6 years of clinical reputed company experience • At least • *1 year of utilization review experience reputed company a managed care or health plan environment Preferred Qualifications • Licensure in multiple states • reputed company Certification in • *Cardiology, Radiation Oncology, or Neurology** • Experience with care management reputed company the health insurance industry • Willingness and ability to obtain additional state licenses as needed Schedule & reputed company • Hours: 8:00 AM – 5:00 PM (local time zone) • reputed company Rotation: 1 weekend every 16 weeks Apply tot his job Apply To this Job