Utilization Management Physician; UMP | Remote

Utilization Management Physician (UMP)

Full-Time | Remote | Florida License Required

We are seeking a Utilization Management Physician (UMP) for a full-time, remote opportunity with a well-established, multi-specialty healthcare organization in Florida. This role requires strong clinical judgment, critical thinking skills, and effective communication to support medical necessity determinations and utilization review processes.

• Review pre-authorization requests, including initial and concurrent clinical review cases
• Conduct post-service clinical reviews, including claims and appeals
• Render determinations based on evidence-based medicine and nationally recognized criteria such as MCG, Inter Qual, and CMS guidelines
• Ensure compliance with regulatory standards for pre-authorization determinations
• Provide clear clinical rationale for non-certification decisions
• Participate in peer‑to‑peer discussions (telephonic or electronic) regarding cases under review
• Be available to address urgent cases with attending providers
• Assist with provider education related to treatment protocols and options
• Participate in committees as requested
• Collaborate with specialty physicians as needed
• Participate in quality review and interrater reliability processes

• MD, DO, or PhD from an accredited medical school
• Active, unrestricted Florida medical license
• Board certification in primary specialty preferred
• 3–5 years of clinical experience
• Experience with managed care and health plan benefits
• Strong understanding of medical policy and application of clinical criteria
• Ability to evaluate complex cases and make sound determinations

• Competitive salary
• Bonus opportunity
• 401(k) Tax Deferred Plan
• Comprehensive health benefits for provider and eligible dependents
• Group life and disability insurance
• Malpractice coverage
• Paid time off
• CME stipend
• Licenses, fees, and dues reimbursement
• Travel reimbursement
• Relocation assistance

This is an excellent opportunity for physicians seeking a remote position with strong work‑life balance while remaining clinically engaged in utilization management.

Thank you for your time, and I look forward to connecting soon!

Manish Parashar
Recruiter, The Provider Finder