Remote Utilization Review Physician

<p><strong>MUST be a board certified Physician </strong></p><p><br></p><p><strong><br>Start date: June 29t</strong></p><p><br></p><p><strong>h<br>Must have one of the bel</strong></p><p><strong>owFL Licen</strong></p><p><strong>seNC Licen</strong></p><p><strong>seIM</strong></p><p><br></p><p><br></p><p>LC<br><br>This organization is a technology-driven health insurance company built on a full-stack platform with a strong focus on member-centered care. Founded in 2012, it was created to deliver the kind of health insurance experience people would want for themselves—one that feels supportive, accessible, and clinically groun</p><p><strong>ded.About the </strong></p><p>RoleYou will evaluate the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guideli</p><p><strong>nes.Ho</strong>urs: 8:00 AM – 5:00 PM (local time z</p><p><strong>one)Call Rotat</strong>ion: One weekend every 16 w</p><p>eeksYou will report to the Associate Medical Director, Utilization Managem</p><p><br></p><p><strong>ent.<br>Key Responsibil</strong></p><ul><li>itiesConduct timely medical reviews in alignment with established quality stan</li><li>dardsMake clinical determinations using evidence-based criteria, internal guidelines, and sound clinical jud</li><li>gmentClearly and accurately document decisions and communications in workflow systems using appropriate temp</li><li>latesEnsure documentation is easy for members to under</li><li>standMeet required turnaround times for re</li><li>viewsReview escalated cases as n</li><li>eededParticipate in peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes, including alternative treatment options when approp</li><li>riateMaintain compliance with all applicable laws and regula</li><li>tionsPerform other duties as ass</li></ul><p><strong>ignedRequire</strong></p><ul><li>mentsBoard-certified MD </li><li>or DOLicensed in Florida or North Carolina and/or eligible for or active participation in the Interstate Medical Licensure Compact (I</li><li>MLCC)Minimum of 6 years of clinical practice exper</li><li>ienceAt least 1 year of utilization review experience within a managed care or health insurance se</li></ul><p><strong>ttingPreferred Qualifica</strong></p><ul><li>tionsLicensure in multiple s</li><li>tatesBoard certification in Cardiology, Radiation Oncology, or Neur</li><li>ologyExperience with care management in the health insurance ind</li><li>ustryWillingness to obtain additional state licenses as needed, with employer su</li></ul><p><strong>pportEqual Opportunity & Accessib</strong></p><p>ilityThis organization is an Equal Opportunity Employer committed to fostering an inclusive and supportive environment where individuals can bring their authentic selves to work. Applicants are evaluated solely on qualificat</p><p>ions.Reasonable accommodations are available for candidates who need them during the application pro</p><p>cess.If you’d like, I can </p><ul><li>also:Shorten this in<strong>to a candidate-facing j</strong></li><li>ob adMake it sound <strong>more cli</strong>nical or <strong>more corp</strong></li><li>orateReformat it<strong> for LinkedIn or recruiter out</strong></li></ul><p><br></p>reach