Physician Reviewer – Utilization Management (Remote)-Full Time Overview We are seeking a Board-Certified Physician to support utilization management activities by reviewing clinical documentation and determining the medical appropriateness of inpatient, outpatient, and pharmacy services. This role plays a critical part in ensuring evidence-based, high-quality, and cost-effective care decisions. The ideal candidate brings strong clinical judgment, experience within managed care, and the ability to apply nationally recognized medical guidelines in a fast-paced, collaborative environment. Key Responsibilities Review and assess medical necessity for inpatient, outpatient, and pharmacy services Apply evidence-based guidelines and medical policy to utilization review determinations Provide peer-to-peer consultations when required Collaborate with care management and clinical teams to support appropriate care delivery Ensure compliance with regulatory, accreditation, and internal quality standards Accurately document decisions within established systems and turnaround times Required Qualifications MD or DO with active Board Certification Active medical license in FL or NC , and/or participation in the Interstate Medical Licensure Compact (IMLC) or eligibility to apply Minimum 6 years of clinical practice experience At least 1 year of utilization review experience within a managed care or health plan environment Preferred Qualifications Licensure in multiple states Board Certification in Cardiology, Radiation Oncology, or Neurology Experience with care management within the health insurance industry Willingness and ability to obtain additional state licenses as needed Schedule & Call Hours: 8:00 AM – 5:00 PM (local time zone) Call Rotation: 1 weekend every 16 weeks
A clinical research organization is seeking a Research Assistant in Los Alamitos, California. This role involves supporting Clinical Research Coordinators with various tasks, maintaining patient charts, and ensuring adherence to protocols. Ideal candidates should possess...
...Job Description Job Description Immediate Openings Assistant County Attorney Location: Manchester, New Hampshire Job Type: Full-Time Department: Hillsborough County Attorneys Office Hillsborough County, the most populous county in New Hampshire (with...
...practice group in the country, now is the perfect time to join our clinical team! We are actively looking to hire talented Psychiatric Nurse Practitioners in the area, who are passionate about patient care and committed to clinical excellence. Is This You?...
...parents to effectively parent their child/ren providing parent education using research and evidenced based tools, provide supervised visitation and ensure safety of children, and provide safety stops for children in the home and observe and report any safety concerns....
About the New York City DOC Legal Division Intern PositionThe New York City Department of Correction (DOC) seeks a graduate intern to join the Office of the General Counsel. Under the supervision of experienced attorneys, interns will have the opportunity to review discovery...