Utilization Management Medical Director - Remote Physician Opening
Job at a glance
Job description
We are seeking a board-certified physician to determine the medical appropriateness of inpatient, outpatient, and pharmacy services. This role involves reviewing clinical information, applying evidence-based guidelines, and making timely, well-documented medical necessity determinations.
You will report to the Associate Medical Director, Utilization Management.
Schedule
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Monday–Friday, 8:00 a.m. – 5:00 p.m. (local time zone)
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Weekend call rotation: approximately 1 weekend every 16 weeks
Location
This is a remote position open to candidates residing in:
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Arizona
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Florida
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Georgia
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Texas
While daily work is performed from a home office, occasional travel may be required for team meetings and company events.
Compensation & Benefits
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Base salary range: $211,200 – $277,200 annually
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Annual performance bonus eligibility
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Comprehensive employee benefits
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Unlimited vacation policy
Job Responsibilities
-Apply evidence-based criteria, internal guidelines, and clinical expertise to make determinations
-Accurately document all decisions and communications in workflow systems using clear, member-friendly language
-Utilize appropriate documentation templates during case reviews
-Meet required turnaround times for clinical reviews
-Conduct peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes, including alternative treatment recommendations based on medical necessity criteria and research
-Ensure compliance with all applicable laws and regulations
-Perform additional duties as assigned
Qualifications
Active medical license in Florida or North Carolina and/or active Interstate Medical Licensure Compact (IMLCC) membership or eligibility
Minimum of 6 years of clinical practice experience
At least 1 year of utilization review experience within a managed care organization