Utilization Review Work for Physicians - Remote, Full Time

Description

PHYSICIAN UTILIZATION REVIEW - POSITION DESCRIPTION

Founded in 1983, Medical Review Institute of America, LLC (MRIoA) has grown into the industry leader in external medical review services, proudly serving over 800 clients nationwide and completing more than 2 million reviews each year.

At MRIoA, we believe our people are the foundation of our success. With a team of nearly 600 dedicated professionals, you're not just another employee — you're a valued and integral part of our mission-driven organization.

As an Associate Medical Director, you will leverage your medical experience and judgment to determine whether requested services, levels of care, and/or sites of service should be authorized. This role operates within a framework of criteria from the patient’s healthcare plan, regulatory compliance, and utilizing diverse resources such as national clinical guidelines, CMS policies, clinical reference materials, internal teaching conferences, and other references.

KEY RESPONSIBILITIES



Medical Decision Making: Leverage in-depth inpatient clinical expertise, including familiarity with MCG/InterQual guidelines and health plan policies, along with acute care, co-morbidities, and disease management experience, to review medical records and deliver evidence-based determinations on service requests.

Communication: Conduct peer-to-peer phone calls with external providers to obtain additional clinical information and discuss case determinations.

Collaboration: Follow established procedures to support internal workflows and foster effective working relationships across teams and stakeholders.

Compliance and Support: Ensure all decisions and processes adhere to national guidelines, CMS regulations, URAC standards, clinical best practices, and contractual requirements.

IDEAL CANDIDATE PROFILE



·        Willing and able to work the structured schedule: This is NOT a flexible position. You will be scheduled 40-45 hours per week (5, 8 hours shifts per week) including weekend shifts. Work hours are between 6:00am – 7:00pm Mountain Time Zone. Your full attention must be dedicated to the position during scheduled hours. No exceptions to the schedule will be permitted.

·        Medical skill and experience: Highly skilled in managing in-patient co-morbidities, with the ability to apply clinical judgement to determine appropriate patient outcome.

·        Computer skill: Be highly adept with computers, possess above average computer literacy.

·        Integrity and Professionalism: Demonstrates a high degree of integrity and professionalism.

·        Resourcefulness: Ability to utilize available resources effectively to make informed decisions.

·        Team Collaboration: Supports and collaborates with team members, other departments, colleagues, and leadership.

·        Independence and Structure: After completing structured and mentored training, performs daily tasks with minimal supervision but with ready support from team members. Enjoys working in a structured environment with consistent thinking and authorship.

·        Compliance and Timeliness: Exercises independence in meeting departmental expectations and compliance timelines.

Requirements

To qualify for this position, you must meet the following requirements:

·        MD or DO degree, with current board certification in Family Medicine or Internal Medicine.

·        5 years of recent direct patient care experience, which must include at least 3 full years of in-patient hospital experience in an acute care setting, ICU experience preferred.

·        Be highly adept with computers, with strong computer literacy.

·        Be willing to obtain up to 20 additional state licenses (MRIoA will manage and cover the cost of licenses and CME requirements to maintain them).

·        Clean background, without any prior licensure issues or pending malpractice (background or malpractice issues can delay the process of obtaining additional licenses).

·        Must have passed each component of the USMLE, COMLEX-USA, or equivalent predecessor exam accepted by the state medical board (such as the FLEX or NBME) in no more than three attempts for each component.

·        You must be fully committed to the job during your scheduled hours. This position does not allow for any caregiving or other responsibilities during your scheduled work hours.

·        You must reside and work within the United States.

MRIoA Privacy Policy: https://www.mrioa.com/privacy/

MRIoA Terms of Use page: https://www.mrioa.com/terms-of-use/

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.

NOTE: For California Residence - California Consumer Privacy Act (CCPA) Information:

·        Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.

Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please contact Medical Review Institute of America (MRIoA) at Contact.