Physician Anesthesiology - Charleston - The Provider Finder

    The Provider Finder
    The Provider Finder Charleston

    17 hours ago

    $300,000 - $550,000 (USD) per year *
    Description

    Job Description

    Utilization Management Physician (UMP)
    Full-Time | Remote | Florida License Required

    We are seeking a Utilization Management Physician (UMP) for a full-time, remote opportunity with a well-established, multi-specialty healthcare organization in Florida. This role requires strong clinical judgment, critical thinking skills, and effective communication to support medical necessity determinations and utilization review processes.

    Key Responsibilities:

    • Review pre-authorization requests, including initial and concurrent clinical review cases

    • Conduct post-service clinical reviews, including claims and appeals

    • Render determinations based on evidence-based medicine and nationally recognized criteria such as MCG, InterQual, and CMS guidelines

    • Ensure compliance with regulatory standards for pre-authorization determinations

    • Provide clear clinical rationale for non-certification decisions

    • Participate in peer-to-peer discussions (telephonic or electronic) regarding cases under review

    • Be available to address urgent cases with attending providers

    • Assist with provider education related to treatment protocols and options

    • Participate in committees as requested

    • Collaborate with specialty physicians as needed

    • Participate in quality review and interrater reliability processes

    Qualifications:

    • MD, DO, or PhD from an accredited medical school

    • Active, unrestricted Florida medical license

    • Board certification in primary specialty preferred

    • 3–5 years of clinical experience

    • Experience with managed care and health plan benefits

    • Strong understanding of medical policy and application of clinical criteria

    • Ability to evaluate complex cases and make sound determinations

    Compensation & Benefits:

    • Competitive salary

    • Bonus opportunity

    • 401(k) Tax Deferred Plan

    • Comprehensive health benefits for provider and eligible dependents

    • Group life and disability insurance

    • Malpractice coverage

    • Paid time off

    • CME stipend

    • Licenses, fees, and dues reimbursement

    • Travel reimbursement

    • Relocation assistance

    This is an excellent opportunity for physicians seeking a remote position with strong work-life balance while remaining clinically engaged in utilization management.

    Thank you for your time, and I look forward to connecting soon

    Manish Parashar
    Recruiter, The Provider Finder

    * This salary range is an estimation made by beBee
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