Utilization Management Physician
Job at a glance
Job description
Specialty: Utilization Management Physician – While often primary care, frequently these physicians come from backgrounds in psychiatry, neurology, pain medicine, and occupational medicine.
All are welcome to apply. We are not able to accept Visa candidates
Location: Daytona, FL (most UR docs are IM or FM in Florida)
Duties: Perform pre-authorization, concurrent, and post-service medical necessity reviews using evidence-based criteria (MCG, InterQual, CMS).
Render clear certification and non-certification determinations, including peer-to-peer and urgent case discussions with providers.
Serve as a clinical resource to UM staff and consult with physicians across specialties as needed.
Support provider education, assist the CMO, and participate in clinical criteria review and updates.
Ensure compliance with all utilization management, regulatory, and accreditation standards.
Requirements: MD/DO unrestricted Florida license, board certification preferred, 3–5 years of clinical experience.
Comp: 240K plus full benefits