Utilization Management Physician

We are seeking a Utilization Management Physician (UMP) for a full-time, remote opportunity with a well-established, multi-specialty healthcare organization in Florida. This role requires strong clinical judgment, critical thinking skills, and effective communication to support medical necessity determinations and utilization review processes.

Key Responsibilities:

• Review pre-authorization requests, including initial and concurrent clinical review cases

• Conduct post-service clinical reviews, including claims and appeals

• Render determinations based on evidence-based medicine and nationally recognized criteria such as MCG, InterQual, and CMS guidelines

• Ensure compliance with regulatory standards for pre-authorization determinations

• Provide clear clinical rationale for non-certification decisions

• Participate in peer-to-peer discussions (telephonic or electronic) regarding cases under review

• Be available to address urgent cases with attending providers

• Assist with provider education related to treatment protocols and options

• Participate in committees as requested

• Collaborate with specialty physicians as needed

• Participate in quality review and interrater reliability processes

Qualifications:

• MD, DO, or PhD from an accredited medical school

• Active, unrestricted Florida medical license

• Board certification in primary specialty preferred

• 3–5 years of clinical experience

• Experience with managed care and health plan benefits

• Strong understanding of medical policy and application of clinical criteria

• Ability to evaluate complex cases and make sound determinations

Compensation & Benefits:

• Competitive salary

• Bonus opportunity

• 401(k) Tax Deferred Plan

• Comprehensive health benefits for provider and eligible dependents

• Group life and disability insurance

• Malpractice coverage

• Paid time off

• CME stipend

• Licenses, fees, and dues reimbursement

• Travel reimbursement

• Relocation assistance

This is an excellent opportunity for physicians seeking a remote position with strong work-life balance while remaining clinically engaged in utilization management.

Thank you for your time, and I look forward to connecting soon!

Manish Parashar
Recruiter, The Provider Finder
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