Licensed Physician Reviewer – Obstetrics & Gynecology (OB/GYN)

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the main physician reviewer for Utilization Management cases.

• Deliver Delegated UM by managing designated territories.

• Set up 2–3 cases daily for each market served, covering up to 6 markets.

• Attend all health plan and local meetings.

• Engage in weekly meetings for Primary Care Providers (PCP) and Skilled Nursing Facilities (SNF) within assigned territories.

• Provide guidance to fellow physician reviewers.

• Contribute to process and quality enhancements in Delegated Utilization Management.

• Carry out additional responsibilities as directed and adjusted by the manager.

⛳️ Requirements

• Must be a graduate of an accredited Medical School and possess a valid, unrestricted license.

• Completion of a residency in Internal Medicine or Family Practice is necessary.

• Board Certification in Obstetrics & Gynecology (OB/GYN) is required.

• Preferred: Two (2) years of experience in Hospital medicine.

• Preferred: At least one (1) year of experience in utilization review.

• Strong analytical and deductive reasoning abilities are essential.

• Good judgment and problem-solving capabilities are necessary.

• Professional and effective communication skills are required.

• Excellent organizational skills are needed.

• Proficiency in both written and verbal English is essential.

• Familiarity with Microsoft Office applications such as Outlook, Excel, Word, and PowerPoint is necessary.

🏝️ Benefits

• Competitive compensation.

• Comprehensive benefits package.

• Opportunities for career development and advancement.

• Excellent work-life balance.