Utilization Management Physician (UMP) - Remote Full-Time 40 Hours Weekly
A leading healthcare organization is seeking an experienced Utilization Management Physician (UMP) for a full-time remote opportunity. This role is ideal for a physician with strong clinical judgment, managed care experience, and expertise in medical necessity review and evidence-based decision-making.
The position is primarily remote, with occasional on-site attendance required for meetings and committee participation in Daytona Beach, Florida.
Position Highlights Remote full-time role
40 hours per week
Bonus opportunity
Must be available via phone, email, and Microsoft Teams
On-site presence required periodically for meetings/committees
Key Responsibilities Review and render determinations for:
Pre-authorization requests
Initial and concurrent clinical reviews
Post-service decisions, including claims and appeals
Apply medical necessity criteria using nationally recognized guidelines, including:
MCG (Milliman Care Guidelines)
InterQual
CMS (Medicare/Medicaid) standards
Internal protocols and coverage documents
Participate in annual review and updates of clinical criteria and scripts
Provide physician support and guidance to Utilization Management staff
Conduct peer-to-peer discussions with treating providers (phone or electronic)
Assist with provider education regarding treatment protocols and best practices
Participate in medical and utilization management committees as requested
Patient/Plan Focus This role supports utilization review across multiple plan types, including:
Medicare
Medicaid
Commercial health plans
Requirements MD or DO from an accredited medical school
Active, unrestricted Florida medical license
Board certification in primary specialty preferred
Minimum 3 years' experience as a Utilization Management Physician
3-7 years of overall clinical experience
Knowledge of managed care health plan operations and benefits
Strong working knowledge of medical policy application and evidence-based criteria
Willingness to participate in audit/interrater reliability processes to ensure consistency
Compensation & Benefits
Annual bonus opportunity
401(k) retirement plan
Health benefits for provider and eligible dependents
Malpractice insurance provided
Paid leave time
CME stipend
Licenses, fees, and dues reimbursement
Travel reimbursement
Location Remote (Florida)
Occasional on-site meetings in Daytona Beach, FL
