Internal Medicine Physician - Daytona Beach - ProTouch Staffing

    ProTouch Staffing
    ProTouch Staffing Daytona Beach

    13 hours ago

    Description
    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

    Location:
    Daytona Beach, FL

    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

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