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Internal Medicine Physician

medixOglesby, TX

32 days ago

Occupations

Physicians, All OtherGeneral Internal Medicine PhysiciansFamily Medicine Physicians

Industries

Offices of PhysiciansGeneral Medical and Surgical HospitalsAll Other Outpatient Care Centers
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About the role

Must hold an active license in NC or FL or have the IMLCWe are seeking a Board-Certified Physician to support utilization management activities by reviewing clinical documentation and determining the medical appropriateness of inpatient, outpatient, and pharmacy services. This role plays a critical part in ensuring evidence-based, high-quality, and cost-effective care decisions. The ideal candidate brings strong clinical judgment, experience within managed care, and the ability to apply nationally recognized medical guidelines in a fast-paced, collaborative environment.
Key Responsibilities:
  • Review and assess medical necessity for inpatient, outpatient, and pharmacy services
  • Apply evidence-based guidelines and medical policy to utilization review determinations
  • Provide peer-to-peer consultations when required
  • Collaborate with care management and clinical teams to support appropriate care delivery
  • Ensure compliance with regulatory, accreditation, and internal quality standards
  • Accurately document decisions within established systems and turnaround times
Required Qualifications:
  • MD or DO with active Board Certification
  • Active medical license in FL or NC, and/or participation in the Interstate Medical Licensure Compact (IMLC) or eligibility to apply
  • Minimum 6 years of clinical practice experience
  • At least 1 year of utilization review experience within a managed care or health plan environment
Preferred Qualifications:
  • Licensure in multiple states
  • Board Certification in Cardiology, Radiation Oncology, or Neurology
  • Experience with care management within the health insurance industry
  • Willingness and ability to obtain additional state licenses as needed
  • Schedule & Call
Hours: 8:00 AM 5:00 PM (local time zone)
Call Rotation: 1 weekend every 16 weeks

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JOB OVERVIEW

Experience level

Senior

Location

Oglesby, TX

Occupation

Physicians, All Other

Industry

Offices of Physicians

Posted

32 days ago

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