Overview Our client is seeking a board-certified Internal Medicine or Family Medicine physician to join our Utilization Management team. This remote opportunity offers the chance to make a meaningful impact on patient care while enjoying the flexibility and support of a global healthcare leader. Join a team that values diversity, innovation, and the Quadruple Aim—enhancing patient experience, improving population health, reducing costs, and supporting provider well-being. Key Responsibilities Utilization Management & Clinical Oversight Develop and maintain an efficient UM program aligned with company values and member needs. Conduct case reviews and determine medical necessity. Stay current with CMS criteria and organizational determination processes. Ensure compliance with CMS and delegated health plan regulations. Perform post-service reviews for medical necessity and benefit determination coding. Contribute to the development of medical, care, and utilization management protocols. Customer Service & Quality Assurance Ensure physician compliance with UM plans. Provide timely, professional responses to physicians and staff. Maintain confidentiality and uphold professional standards. Educate and counsel on medical technologies, review criteria, and UM policies. Professional Development & Collaboration Actively participate in physician meetings and onboarding. Mentor and support team members through knowledge sharing and education. Attend continuing education to stay abreast of medical advancements and best practices. Required Qualifications M.D., D.O., or M.B.B.S. Board certification in Internal Medicine or Family Medicine Active, unrestricted medical license (any U.S. state) Minimum 5 years of post-residency clinical practice experience Proficiency in Microsoft Office applications Preferred Qualifications 2+ years of experience in utilization management 2+ years of experience with acute admissions Experience in a managed care health plan environment Bilingual fluency in English and Spanish Location: Remote • Hours: 40 hours per week • Job Type: Contract to Hire • Rate: Starting at $140.00/hour

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