Clinical/Physician Reviewer — Utilization Management
MD / DO · Part-Time, 1099 · Remote (US-Based) · Flexible Hours incl. Evenings & Weekends
ABOUT SYNCHEALTHCARE
SyncHealthcare is a healthcare management company dedicated to improving appropriate access and quality care for patients. We are committed to advancing the quality, safety, and efficiency of the healthcare system — and we believe that starts with the right clinical expertise on our team.
POSITION OVERVIEW
We are seeking experienced, board-certified physicians (MD/DO) to join our Utilization Management (UM) Reviewer Panel as independent contractors. In this role, you will serve as a subject matter expert ensuring that services are clinically appropriate, evidence-based, and compliant with standard of care..
This is a fully remote 1099 opportunity — offering genuine flexibility alongside meaningful clinical impact to patients across commercial, Medicare, Medicaid, and delegated plan contracts.
KEY RESPONSIBILITIES
• Conduct physician-level clinical reviews for prior authorization, concurrent review, retrospective review, and appeals across multiple lines of business.
• Apply nationally recognized clinical criteria (InterQual, MCG, ASAM), health plan policies, and regulatory requirements (CMS, Medicaid, NCQA, URAC).
• Render timely, well-documented clinical determinations consistent with required turnaround times.
• Conduct peer-to-peer with treating providers to communicate decisions and advance evidence-based care.
• Evaluate provider-submitted documentation to assess medical necessity, appropriateness of care, and benefit coverage.
• Support appeals, grievances, and hearings with clear, defensible, evidence-based clinical rationale.
• Collaborate with UM nurses, case managers, and multidisciplinary care teams.
• Serve as a clinical resource for internal teams on UM protocols, clinical policies, and specialized care pathways.
• Maintain strict compliance with HIPAA, privacy, and confidentiality requirements.
• Contribute to quality improvement initiatives, audits, and ongoing training efforts.
• Provide actionable feedback to leadership to continuously improve care services and operational processes.
QUALIFICATIONS
Required
• MD or DO degree from an accredited institution.
• Active, unrestricted U.S. medical license (multi-state licensure strongly preferred).
• Board certification through an ABMS- or AOA-recognized specialty board.
• Active clinical practice with direct patient care within the past 3 years.
• Minimum 5 years of clinical practice experience within your specialty.
• Proficiency with EMR systems and/or UM review platforms.
• Strong written and verbal communication skills, particularly for peer-to-peer discussions and clinical documentation.
Preferred
• At least 1 year of UM, peer review, or managed care experience.
• Familiarity with evidence-based clinical guidelines and UM criteria (InterQual, MCG, ASAM, LCD, NCD etc).
• Multi-state licensure or openness to obtaining additional state licenses.
HIGH-PRIORITY SPECIALTIES
We are actively recruiting reviewers across a broad range of specialties. Current high-priority areas:
1. Gastroenterology
2. Dermatology
3. Radiology (Diagnostic, Interventional)
4. Neurosurgery
5. Neurology (Stroke, MS, Epilepsy, Headache/Migraine, Neurocritical Care)
6. Orthopedic Surgery (Spine, Joint Replacement, Trauma, Sports Medicine)
7. Nephrology (General, Transplant, Dialysis)
8. Surgery (Trauma/Critical Care, Plastic & Reconstructive, Pediatric, Vascular)
9. Cardiology (General, Interventional, EP, Heart Failure/Transplant, Cardiac Rehab)
10. EENT
11. Ophthalmology
12. Allergy and Immunology
13. Urology
14. Anesthesia
15. Hematology-Oncology (Medical, Radiation, Immunotherapy, Transplant, Surgical Oncology)
16. Rheumatology and Immunology
17. Pediatrics ( General and other Subspecialties)
18. Pulmonology (General, Sleep Medicine and/or Critical Care)
19. Psychiatry / Behavioral Health (Adult, Child & Adolescent, SUD, Inpatient, Residential)
20. Internal Medicine / Family Medicine (Hospitalist, Critical Care, Addiction Medicine, SNFist)
OTHER OPEN POSITIONS
• Medical Director — Utilization Management (MD/DO), Part-Time, 1099
• UM Case Manager — Utilization Management (RN), Part-Time or Full-Time
• UM Case Coordinator — Utilization Management, Part-Time or Full-Time
Ready to Make an Impact? Submit your resume or inquiry to info@synchealthcare.org. We’d love to learn more about your clinical expertise.
SyncHealthcare · Improving Quality and Access. Advancing Care.
