Physician Reviewer (MD/DO) – Utilization Management (Remote)

About the role

We are looking for an experienced MD or DO to join our Utilization Management team as a Physician Reviewer. This remote, full‑time position focuses on evaluating the medical necessity of inpatient, outpatient, and pharmacy services using evidence‑based guidelines.

Key responsibilities

• Conduct timely utilization reviews for inpatient, outpatient, and pharmacy claims.
• Apply clinical guidelines and internal policies to determine medical necessity.
• Review escalated cases and provide recommendations to providers.
• Participate in peer‑to‑peer discussions with treating physicians.
• Document decisions clearly within workflow systems and meet turnaround targets.
• Collaborate with care management and utilization management teams to ensure compliance with regulations.

Required profile

• Board‑certified MD or DO with an active medical license in Florida or North Carolina (or eligible via the Interstate Medical Licensure Compact).
• Minimum 6 years of clinical practice experience.
• At least 1 year of utilization review experience in a managed‑care or health‑insurance setting.
• Strong communication and documentation abilities.
• Team‑oriented, collaborative mindset.

Required skills

What we offer

• Competitive base salary $260,000–$275,000 per year.
• Annual performance bonus eligibility.
• Comprehensive medical, dental, vision, 401(k) with company match.
• Generous PTO/unlimited vacation, paid holidays, wellness time, parental leave.
• Life and disability insurance.