Remote Utilization Review Physician

MUST be a board certified Physician

Start date: June 29t

h
Must have one of the bel

owFL Licen

seNC Licen

seIM

LC

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

ded.About the

RoleYou will evaluate the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guideli

nes.Hours: 8:00 AM – 5:00 PM (local time z

one)Call Rotation: One weekend every 16 w

eeksYou will report to the Associate Medical Director, Utilization Managem

ent.
Key Responsibil
• itiesConduct timely medical reviews in alignment with established quality stan
• dardsMake clinical determinations using evidence-based criteria, internal guidelines, and sound clinical jud
• gmentClearly and accurately document decisions and communications in workflow systems using appropriate temp
• latesEnsure documentation is easy for members to under
• standMeet required turnaround times for re
• viewsReview escalated cases as n
• eededParticipate in peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes, including alternative treatment options when approp
• riateMaintain compliance with all applicable laws and regula
• tionsPerform other duties as ass

ignedRequire
• mentsBoard-certified MD
• or DOLicensed in Florida or North Carolina and/or eligible for or active participation in the Interstate Medical Licensure Compact (I
• MLCC)Minimum of 6 years of clinical practice exper
• ienceAt least 1 year of utilization review experience within a managed care or health insurance se

ttingPreferred Qualifica
• tionsLicensure in multiple s
• tatesBoard certification in Cardiology, Radiation Oncology, or Neur
• ologyExperience with care management in the health insurance ind
• ustryWillingness to obtain additional state licenses as needed, with employer su

pportEqual Opportunity & Accessib

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

ions.Reasonable accommodations are available for candidates who need them during the application pro

cess.If you’d like, I can
• also:Shorten this into a candidate-facing j
• ob adMake it sound more clinical or more corp
• orateReformat it for LinkedIn or recruiter out

reach