Licensed physician Reviewer

ChenMed•Miami Gardens, FL

10d•$204,761 - $292,515•Remote

About The Position

The Physician Reviewer serves as the primary physician reviewer for Utilization Management (UM) cases and provides Delegated UM coverage for assigned territories. The role advises other physician reviewers, joins daily calls with health plan and local teams, and helps coordinate patient care. It also contributes to process and quality improvement in the developing Delegated Utilization Management area. The reviewer covers assigned markets, establishes 2–3 cases per day for each market (up to six markets), attends required health plan and local calls, and participates in weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings for assigned territories. Other duties may be assigned or modified by the manager.

Requirements

Graduate from an accredited medical school.
Hold a valid, unrestricted medical license.
Complete an Internal Medicine or Family Practice residency.
Hold board certification in the residency area.
Demonstrate excellent analytical and deductive reasoning skills.
Demonstrate good judgment and problem-solving skills.
Have professional and effective communication skills.
Have strong organizational skills.
Be fluent in written and spoken English.
Be proficient with Microsoft Office products, including Outlook, Excel, Word, and PowerPoint.

Nice To Haves

Two years of hospital medicine experience preferred.
At least one year of utilization review experience preferred.

Responsibilities

Provide Delegated Utilization Management coverage for assigned territories.
Establish 2–3 cases per day for each assigned market, covering up to six markets.
Attend health plan and local calls.
Participate in weekly PCP and SNF meetings for assigned territories.
Advise other physician reviewers.
Participate in process and quality improvement in Delegated Utilization Management.
Coordinate care for patients.
Perform other duties as assigned or modified by the manager.