About the job
Physician – Utilization Management (MD/DO)
Location: Remote (U.S.)
Schedule: Monday–Friday, 8:00 AM–5:00 PM (local time zone)
Call Rotation: 1 weekend every 16 weeks
Salary: $260,000–$275,000
About the Role
We are seeking a Board-Certified Physician (MD/DO) to support Utilization Management (UM) activities by determining the medical appropriateness of inpatient, outpatient, and pharmacy services.
In this role, you will apply evidence-based clinical guidelines and medical policy to ensure appropriate, high-quality, and cost-effective care across the healthcare continuum.
Key Responsibilities
- Review clinical documentation to determine medical necessity for inpatient, outpatient, and pharmacy services
- Apply evidence-based guidelines and internal medical policies to utilization management decisions
- Collaborate with care management teams and clinical staff to support appropriate care delivery
- Ensure decisions align with regulatory, accreditation, and organizational standards
- Participate in peer-to-peer discussions as needed to support utilization determinations
Required Qualifications
- MD or DO from an accredited medical school
- Board Certified Physician
- Active medical license in Florida or North Carolina, or eligibility through the Interstate Medical Licensure Compact (IMLCC)
- 6+ years of clinical practice experience
- 1+ year of Utilization Review/Utilization Management experience in a managed care or health plan environment
Preferred Qualifications
- Licensure in multiple states
- Board Certification in Cardiology, Radiation Oncology, or Neurology
- Experience in care management within the health insurance industry
- Willingness and ability to obtain additional state licensure as needed
Why Join Us?
- Predictable weekday schedule with minimal call rotation
- Opportunity to impact patient care at a system level
- Remote work environment with strong collaboration across clinical teams
- Work within a physician-led organization focused on quality and efficiency
Hiring Restrictions
At this time, we are unable to hire candidates residing in the following states:
Alaska • Delaware • Hawaii • Louisiana • Montana • Nebraska • North Dakota • Oklahoma • West Virginia • Wyoming
Equal Opportunity Employer
We are an Equal Opportunity Employer committed to fostering a diverse and inclusive workplace where all employees feel valued and supported.
