Utilization Management Physician Reviewer

For our client, we are seeking a Utilization Management Physician Reviewer to join the team of a leader in the Healthcare space. This remote role is focused on evaluating service requests and making clinically sound utilization management decisions that support appropriate care delivery. You will apply evidence-based criteria, partner with care teams, and help ensure decisions align with regulatory, accreditation, and medical policy requirements. The position also contributes to process improvement efforts that strengthen utilization management operations and patient outcomes across the organization. Location: Remote - US based candidates only, no visa sponsorship available Compensation: $174,070 – $374,920 annually Responsibilities Review service requests and document determinations clearly in accordance with policy Apply evidence-based criteria to utilization management decisions Collaborate with care teams to support effective patient care delivery Stay current on CMS and MCG guidelines relevant to utilization management Ensure compliance with legal, regulatory, and accreditation standards Participate in initiatives to improve utilization management processes Assist with formal responses to health plans as needed Qualifications M.D. or D.O. degree from an accredited medical school Current, unrestricted U.S. medical license 1+ years of experience in utilization management for Medicare/Medicaid 3-5 years of clinical practice in primary care Strong understanding of managed care and care coordination Excellent verbal and written communication skills Demonstrated commitment to culturally responsive care Benefits Comprehensive medical, dental, and vision coverage Paid time off Retirement savings options Wellness programs Resources for physical, emotional, and financial well-being Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.