Utilization Management Physician

Charleston, SC - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Utilization Management Physician (UMP)
Full-Time Remote Florida License Required

We are seeking a Utilization Management Physician (UMP) for a full-time remote opportunity with a well-established multi-specialty healthcare organization in Florida. This role requires strong clinical judgment critical thinking skills and effective communication to support medical necessity determinations and utilization review processes.

Key Responsibilities:

Review pre-authorization requests including initial and concurrent clinical review cases
Conduct post-service clinical reviews including claims and appeals
Render determinations based on evidence-based medicine and nationally recognized criteria such as MCG InterQual and CMS guidelines
Ensure compliance with regulatory standards for pre-authorization determinations
Provide clear clinical rationale for non-certification decisions
Participate in peer-to-peer discussions (telephonic or electronic) regarding cases under review
Be available to address urgent cases with attending providers
Assist with provider education related to treatment protocols and options
Participate in committees as requested
Collaborate with specialty physicians as needed
Participate in quality review and interrater reliability processes

Qualifications:

MD DO or PhD from an accredited medical school
Active unrestricted Florida medical license
Board certification in primary specialty preferred
35 years of clinical experience
Experience with managed care and health plan benefits
Strong understanding of medical policy and application of clinical criteria
Ability to evaluate complex cases and make sound determinations

Compensation & Benefits:

Competitive salary
Bonus opportunity
401(k) Tax Deferred Plan
Comprehensive health benefits for provider and eligible dependents
Group life and disability insurance
Malpractice coverage
Paid time off
CME stipend
Licenses fees and dues reimbursement
Travel reimbursement
Relocation assistance

This is an excellent opportunity for physicians seeking a remote position with strong work-life balance while remaining clinically engaged in utilization management.

Thank you for your time and I look forward to connecting soon!

Manish Parashar
Recruiter The Provider Finder

Required Experience:

Utilization Management Physician (UMP)Full-Time Remote Florida License RequiredWe are seeking a Utilization Management Physician (UMP) for a full-time remote opportunity with a well-established multi-specialty healthcare organization in Florida. This role requires strong clinical judgment critical...