Daytona Beach, Florida, Utilization Review Physician Opening - Remote Position
Updated 2/26/26
Daytona Beach, Florida, United States
Physician
Family Practice-Without OB
By applying you agree to our Terms of Service
Job at a glance
Degree Required
MD/DO
Position Type
Full-Time
Work Environment
Hospital
Clinic/Private Practice
Visa Sponsorship
No
Job description
Job description
Daytona Beach, Florida, Utilization Review Physician Opening - Remote Position
Do you know someone that might be a good fit for this position? Please ask about our generous referral fees!
Overview:
A large multi-specialty staff model HMO, is seeking a Utilization Management Physician (UMP). This full-time, remote position requires critical thinking skills, effective communication, and decisive judgement. The ideal candidate will have a working knowledge of the responsibilities listed.
Clinical Role:
Review pre-authorization requests, initial clinical review, and concurrent clinical review cases. Review post-service clinical decisions including claims and appeals.
Render determinations based on relevant clinical information, medical necessity determined by using evidence-based medicine, nationally recognized criteria (i.e. MCG (formally Milliman), InterQual, Centers for Medicare and Medicaid), FHCP Protocols, and the Member’s FHCP Coverage Documents.
Review clinical criteria and scripts at least annually and update if necessary.
Assist the CMO in Provider education regarding treatment protocols, treatment options, etc., as appropriate.
Be available to staff to answer questions regarding cases under review.
Be available for peer-to-peer discussions of cases under initial or concurrent review either in person, by telephone, or electronically.
Meet current regulatory standards regarding pre-authorization determinations.
Be available to discuss urgent cases directly with attending provider.
For non-certification decisions, specifies the principal reason for the determination not to certify and the clinical rationale for the non-certification.
Consult with other physicians in medical specialty areas as needed.
Participate in organization committees at the request of the CMO.
Practitioner Requirements
Practitioner must meet the following minimum requirements to serve as a Utilization Management Practitioner(“UMP”) for the organization:
MD, DO, or PhD degree from an accredited medical school.
Licensed to practice medicine in the state of Florida without restriction.
Board certified in Internal Medicine or Family Medicine.
Have three (3) to five (5) years clinical experience.
Medical Review Officer
Physician Adviser / Physician Reviewer
Knowledge and experience with managed care health plan and benefits
Ability to provide medical knowledge to facilitate resolution of complex issues and required decisions.
Working knowledge of medical policy and application of criteria
Agree to participate in the Interrater Reliability Tool or such other audit process employed by the organization to ensure consistent application of medical policy and coverage criteria.
This is a remote role with in person visits to the Daytona Beach Area. Qualified applicants must be within a reasonable driving distance.
Organization Information:
Competitive salary
Bonus opportunity
401(K) Tax Deferred Plan
HMO Health Benefits for provider & eligible dependents
Group Term Life
Group Disability ·
Malpractice Insurance
Paid Leave Time
CME Stipend
Licenses, Fees & Dues reimbursed.
Travel Reimbursement
Relocation Assistance
Comprehensive network of medical practices and services across Florida
Care Centers that combine doctors, pharmacies, labs, and urgent care under one roof for convenience
Over 9,000 in-network providers offering specialties such as internal medicine, family medicine, psychiatry, endocrinology, cardiology, general surgery, and more
Strong Referral Network
Lifestyle Information:
Live in a beautiful family-oriented area on Florida’s southeast coast
An abundance of stunning beaches, parks, and attractions
Live in one of Florida’s most popular destinations
Enjoy a laid-back lifestyle where you can be outside year-round with access to great restaurants, shops, and more
No state income tax
Ideal Area for A Variety of Water Sports and Recreational Activities
Conveniently Located to Major Airports
Excellent Public & Private Schools
1 hour from Orlando
1 hour from St. Augustine
3 hours from Tampa
4.5 hours from Miami
RecruitWell's Core Values:
Open communication
Sense of urgency
Teamwork
Accountability
Driven to win
Higher consciousness
By applying you agree to our Terms of Service