Utilization Management Physician (UMP) - Remote - Florida

Utilization Management Physician (UMP) - Remote

Full-Time | 40 Hours Weekly

A leading healthcare organization is seeking an experienced Utilization Management Physician (UMP) for a full-time remote opportunity. This role is ideal for a physician with strong clinical judgment, managed care experience, and expertise in medical necessity review and evidence-based decision-making.

The position is primarily remote, with occasional on-site attendance required for meetings and committee participation in Daytona Beach, Florida.

Position Highlights

• Remote full-time role

• 40 hours per week

• Bonus opportunity

• Must be available via phone, email, and Microsoft Teams

• On-site presence required periodically for meetings/committees

  • Location: Daytona Beach, FL

Key Responsibilities

• Review and render determinations for:

  • Pre-authorization requests

  • Initial and concurrent clinical reviews

  • Post-service decisions, including claims and appeals

• Apply medical necessity criteria using nationally recognized guidelines, including:

  • MCG (Milliman Care Guidelines)

  • InterQual

  • CMS (Medicare/Medicaid) standards

  • Internal protocols and coverage documents

• Participate in annual review and updates of clinical criteria and scripts

• Provide physician support and guidance to Utilization Management staff

• Conduct peer-to-peer discussions with treating providers (phone or electronic)

• Assist with provider education regarding treatment protocols and best practices

• Participate in medical and utilization management committees as requested

Patient/Plan Focus

This role supports utilization review across multiple plan types, including:

• Medicare

• Medicaid

• Commercial health plans

Requirements

• MD or DO from an accredited medical school

• Active, unrestricted Florida medical license

• Board certification in primary specialty preferred

• Minimum 3 years' experience as a Utilization Management Physician

• 3-7 years of overall clinical experience

• Knowledge of managed care health plan operations and benefits

• Strong working knowledge of medical policy application and evidence-based criteria

• Willingness to participate in audit/interrater reliability processes to ensure consistency

Compensation & Benefits

• Annual bonus opportunity

• 401(k) retirement plan

• Health benefits for provider and eligible dependents

• Malpractice insurance provided

• Paid leave time

• CME stipend

• Licenses, fees, and dues reimbursement

• Travel reimbursement

Location

Remote (Florida)
Occasional on-site meetings in Daytona Beach, FL