Determine medical appropriateness of inpatient, outpatient, and pharmacy services using guidelines.
Review clinical information to inform decisions.
Document all communications and decisions clearly in workflow tools.
Use correct templates for documenting decisions during case review.
Meet turnaround times for clinical reviews.
Review escalated reviews and participate in peer discussions.

🎯 Requirements

Board certification as an MD or DO.
Licensed in FL or NC and/or active/eligible IMLCC.
6+ years of clinical practice.
1+ years of utilization review in a managed care plan.

🎁 Benefits

Medical, dental, and vision benefits.
11 paid holidays, paid sick time, parental leave.
401(k) with company match; life and disability insurance.
Unlimited vacation and annual performance bonuses.
Remote work from home with occasional travel.

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