Top 142 Physician reviewer Jobs in Remote

Utilization Management Physician Reviewer (Weekends)
Toney HealthCare Consulting, LLC —Remote
- $175 - $200 an hour
- Part-time
- Remote
- Medicine
- 3 years
- Senior level
- Health insurance
Quick Apply
14d
Physician Reviewer (Hematology / Oncology / ENT / Orthopedics / Radiology / Urology)
TMF Health Quality Institute —Remote
- $10 - $150 an hour
- Contract
- Remote
- Medicine
- BC/BE
- Senior level
Quick Apply
Medical Record Review Nurse (RN)-New York Licensed
National Medical Reviews, Inc. —Remote
- $65,000 - $70,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- Employee assistance program
- Flexible schedule
Quick Apply
Physician Reviewer
MedReview —Remote
- $230,000 a year
- Full-time
- Remote
- Medicine
- 5 years
- BC/BE
Quick Apply
Freelance Medical Reviewer, MyHealthTeam
MyHealthTeam —Remote
- $20 - $75 an hour
- Remote
- Medicine
- Mid-level
- Psychology
Board-Certified Physician for Disability Appeal Reviews
Emperion —Remote
- Part-time
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
- Neurology
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Clinical Data Specialist, Clinical Data Specialists
Amazon.com Services LLC —Remote
- $20 - $29 an hour
- Full-time
- Fair chance
- 1 year
- Entry level
- Employee assistance program
- 401(k) matching
Physician Reviewer - Utilization Management (Part Time)
Oscar Health —New York, NY
- $130 - $145 an hour
- Part-time
- Remote
- Medicine
- BC/BE
- Travel
- Paid parental leave
- Paid holidays
Quick Apply
11d
Initial Clinical Reviewer
Enlyte —Remote
- $59,000 - $73,000 a year
- Full-time
- Remote
- Clinic experience
- Mid-level
- Analysis skills
- Health savings account
- AD&D insurance
Physician Reviewer Multiple Specialties - TEXAS and NEW MEXICO
Federal Hearings And Appeals —Wilkes-Barre, PA
- Contract
- Remote
- Medicine
- Surgery
- Addiction Medicine
Quick Apply
Licensed Physician Reviewer
Chen Medical Associates —Miami, FL
- Full-time
- Remote
- Mid-level
- Opportunities for advancement
Physician Medical Reviewer
viva —Remote
- $17 - $22 an hour
- Weekends as needed
- Medicine
- 5 years
- Senior level
10d
Licensed Physician Reviewer (Remote) PRN - Radiology
Chen Medical Associates —Miami, FL
- $204,761 - $292,515 a year
- Full-time
- Remote
- Medicine
- Microsoft Excel
- Microsoft Outlook
- Opportunities for advancement
Clinical Reviewer, Physician Assistant
Cohere Health —Remote
- $120,000 - $135,000 a year
- Mid-level
- 3 years
- Travel
- Paid parental leave
- Health savings account
Quick Apply
1d
PEER REVIEWER - ADDICTION MEDICINE PHYSICIAN - REMOTE
MICHIGAN PEER REVIEW ORGANIZATION —Remote
- Remote
- Microsoft Word
- Medicine
- Addiction Medicine
Quick Apply
Physician Reviewer-Radiology (Part Time)
Evolent Health —Remote
- $95 - $100 a day
- Part-time
- Background check
- Medicine
- Computer literacy
- Health insurance
Licensed Physician Reviewer-GI (remote)
Chen Medical Associates —Miami, FL
- $204,761 - $292,515 a year
- Full-time
- Remote
- Medicine
- Microsoft Excel
- Microsoft Outlook
- Opportunities for advancement
Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
Broadway Ventures —Washington, DC
- Part-time
- Remote
- Surgery
- BC/BE
- Writing skills
- Disability insurance
- Dental insurance
Medical Consultant Reviewer - Internist PRN or Part-Time
COMAGINE HEALTH —Washington, DC
- $140 - $148 an hour
- Part-time
- Remote
- Medicine
- Internal Medicine
- Travel
- Paid parental leave
- Health insurance
Quick Apply
Licensed Physician Reviewer, Ophthalmology - Remote PRN
Chen Medical Associates —Miami, FL
- $204,761 - $292,515 a year
- Full-time
- Remote
- Medicine
- Microsoft Excel
- Microsoft Outlook
- Opportunities for advancement
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physician reviewer jobs near remote

Utilization Management Physician Reviewer (Weekends)

Toney HealthCare Consulting, LLC -
Remote

Quick Apply

Job Details

Part-time | Contract
$175 - $200 an hour
14 days ago

Benefits

Health insurance

Qualifications

Teamwork
Medicare
Electronic health records (EHR) management
Utilization management
Quality improvement
Resource utilization in healthcare
Medical License
Documentation review

Full Job Description

Job Overview

The Physician Reviewer serves as a clinical subject matter expert in the Utilization Management (UM) department. This role is responsible for conducting clinical reviews of medical necessity, appropriateness of care, and service requests based on evidence-based guidelines, medical policy, and regulatory requirements. The Physician Reviewer collaborates with UM nurses, medical directors, and other healthcare professionals to ensure appropriate, timely, and cost-effective care for members.

Key Responsibilities:

Conduct physician-level reviews of prior authorization, concurrent review, and retrospective review cases across multiple lines of business (e.g., commercial, Medicaid, Medicare).
Apply nationally recognized clinical criteria (e.g., MCG, InterQual), internal medical policies, and applicable regulations (CMS, NCQA, URAC) to review determinations.
Render clinical decisions in a timely manner consistent with regulatory timeframes and health plan policies.
Collaborate with medical directors, case managers, and care teams to support optimal care pathways.
Participate in audits, appeals, and grievance processes as needed.
Maintain current knowledge of clinical best practices, industry trends, and regulatory changes.
Participate in peer-to-peer discussions with attending physicians to communicate UM decisions and promote evidence-based care.
Analyze clinical data and documentation to support accurate determinations and appeals.
Contribute to the development and refinement of clinical policies and UM protocols specific to specialized care.
Provide guidance on clinical appropriateness, benefit coverage, and policy interpretation.
Provide education and clinical support to internal teams and external providers regarding best practices and clinical pathways.
Ensure compliance with regulatory, accreditation, and legal requirements in all UM activities.
Ensure adherence to all HIPAA, confidentiality, and privacy standards.
Participate in quality improvement initiatives and clinical case rounds.

Qualifications:

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree required.
Active and unrestricted medical license.
Minimum of 5 years of clinical practice experience in the respective specialty.
At least 3 years of experience in utilization management within a health plan.
Familiarity with evidence-based guidelines and UM tools (e.g., InterQual, MCG).
Strong communication and documentation skills.
Proficiency with electronic medical records and clinical review platforms.
Experience with Medicare/Medicaid and commercial insurance regulations is preferred.
Availability to work weekends (part-time or full-time) between 8:00 AM and 5:00 PM ET on Saturdays and/or Sundays is required.
One week of training is required during normal business hours.

Preferred Skills:

Experience with Medicare and/or Medicaid managed care plans.
Knowledge of medical necessity appeal processes and peer review protocols.
Knowledge of CMS, NCQA, and/or URAC standards.
Previous peer review or medical director experience.
Comfortable working in a remote, collaborative environment.

Pay: $175.00 - $200.00 per hour

Application Question(s):

Availability to work weekends (part-time or full-time) between 8:00 AM and 5:00 PM ET on Saturdays and/or Sundays is required.

Experience:

Utilization Management Review: 3 years (Required)
Medicare and/or Medicaid: 2 years (Preferred)

License/Certification:

Board-certified M.D. or D.O. medical license? (Required)

Work Location: Remote

Quick Apply

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physician reviewer jobs in remote

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