• Remote UM Physician Reviewer

    Insight Global (New York, NY)


    Job Description

    Insight Global is hiring a fully remote Physician Reviewers for a leading health insurance company. The Physician Reviewer will review requests for care before, during, and after treatment to confirm they follow medical guidelines and company policies. This includes checking different types of services like hospital stays, rehab care, medical equipment, and outpatient treatments. They document their decisions clearly so members can easily understand them, and they use the right templates to keep everything consistent. Physician Reviewers also talk directly with doctors when needed to explain decisions or suggest alternative treatments based on medical evidence. They work quickly to meet deadlines, follow all laws and regulations, and handle other related tasks as needed. This is a remote position that requires strong attention to detail, clear communication, and the ability to make informed decisions quickly.

     

    We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

     

    Skills and Requirements

     

    - Board certification as an MD or DO…FL highly preferred

     

    - 5-6+ years of clinical practice…can be flexible

     

    - 1+ years of utilization review experience in a managed care plan (health care industry) - Licensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC.