Physician Job: Physician Reviewer Opportunity | Apply Now
Are you looking for a Physician job in the United States with a strong clinical impact and work-life balance? Medix™ is hiring a Physician Reviewer for a technology-driven health insurance company focused on member-centered care. This opportunity is ideal for experienced MDs seeking stable md jobs in the health insurance industry and exploring rewarding jobs in US healthcare beyond traditional clinical practice.
Job details:
- Job Position: Physician Reviewer
- Company: Medix
- Location: United States
About the Company:
This organization is a technology-driven health insurance company built on a full-stack platform with a strong focus on member-centered care. Founded in 2012, it was created to deliver the kind of health insurance experience people would want for themselves—one that feels supportive, accessible, and clinically grounded. The company combines technology and clinical expertise to improve healthcare access and outcomes. For physicians seeking non-clinical md jobs, this organization offers meaningful career opportunities within the growing health insurance sector in the United States.
Job Description:
This Physician job involves evaluating the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. You will report to the Associate Medical Director, Utilization Management.
Qualifications:
Essential:
- Board-certified MD or DO
- Licensed in Florida or North Carolina and/or eligible for or actively participating in the Interstate Medical Licensure Compact (IMLCC)
- Minimum of 6 years of clinical practice experience
- At least 1 year of utilization review experience within a managed care or health insurance setting
Preferred:
- Licensure in multiple states
- Board certification in Cardiology, Radiation Oncology, or Neurology
- Experience with care management in the health insurance industry
- Willingness to obtain additional state licenses as needed, with employer support
Key Responsibilities:
- Conduct timely medical reviews in alignment with established quality standards
- Make clinical determinations using evidence-based criteria, internal guidelines, and sound clinical judgment
- Clearly and accurately document decisions and communications in workflow systems using appropriate templates
- Ensure documentation is easy for members to understand
- Meet required turnaround times for reviews
- Review escalated cases as needed
- Participate in peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes, including alternative treatment options when appropriate
- Maintain compliance with all applicable laws and regulations
- Perform other duties as assigned
