Fully Remote
Must have FL, NC or an IMLC
Must live in AZ, FL, FA, or TX

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.

About the Role

You will evaluate the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

Hours: 8:00 AM 5:00 PM (local time zone)

Call Rotation: One weekend every 16 weeks

You will report to the Associate Medical Director, Utilization Management.

Work Location:

This is a fully remote position open to candidates residing in Arizona, Florida, Georgia, or Texas. While daily work is completed from a home office, occasional travel may be required for team meetings or company events.

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

Requirements

Board-certified MD or DO

Licensed in Florida or North Carolina and/or eligible for or active participation 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 Qualifications

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

Equal Opportunity & Accessibility

This organization is an Equal Opportunity Employer committed to fostering an inclusive and supportive environment where individuals can bring their authentic selves to work. Applicants are evaluated solely on qualifications.

Reasonable accommodations are available for candidates who need them during the application process.

If you d like, I can also:

Shorten this into a candidate-facing job ad

Make it sound more clinical or more corporate

Reformat it for LinkedIn or recruiter outreach