Utilization Review - Physician Advisor

Advisor, Medical Expert – Internal Medicine PhysicianPosition: Advisor Medical Expert (Utilization Review – Internal Medicine PhysicianWork Location: 100% Remote (Must reside within the Continental U.S.)Schedule: Monday – Friday, Pacific Standard Time (PST) Business HoursTarget Compensation: $220,000 – $235,000 / year (Based on experience)Role SummaryWe are seeking an experienced Internal Medicine Physician to join a collaborative, high-impact remote clinical team supporting Medicaid and government healthcare programs.In this role, you will leverage your extensive clinical expertise to evaluate complex medical cases, assess medical necessity, and ensure members receive appropriate, high-quality, evidence-based care. You will serve as a trusted clinical resource—partnering with treating physicians, care management teams, health plan clients, and healthcare providers to make informed determinations and resolve challenging clinical situations.This position offers a unique opportunity to apply your clinical judgment beyond traditional bedside practice, directly impacting healthcare quality, utilization management, and equitable care access at scale.Key ResponsibilitiesClinical Expertise: Serve as a subject matter expert in Internal Medicine and General Medicine for government healthcare and Medicaid programs.Medical Review & Utilization Management: Conduct clinical evaluations of complex authorization requests, appeals, and medical necessity reviews across inpatient, outpatient, post-acute, and specialty care settings.Peer-to-Peer Engagement: Lead collaborative peer-to-peer consultations with treating physicians and providers to discuss clinical decisions, evidence-based care standards, and treatment plans.Policy & Program Guidance: Interpret Medicaid regulations, medical policies, and established clinical guidelines to make sound determinations and inform care strategies.Multidisciplinary Collaboration: Provide ongoing clinical direction to teams in utilization management, care management, quality improvement, and operations.Quality & Policy Refinement: Contribute to the continuous development and refinement of clinical policies, review criteria, and high-risk case management programs.Qualifications & RequirementsEducation: Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited institution.Licensure: Active, unrestricted California Medical License (Required).Board Certification: Board Certification in Internal Medicine, Family Medicine, or a related primary care specialty.Clinical Experience: Minimum of 5 years of post-residency clinical experience in Internal Medicine, Hospital Medicine, General Practice, or primary care.Utilization Review Knowledge: Experience performing utilization management, prior authorizations, medical necessity reviews, and/or appeals.Subject Knowledge: Deep understanding of evidence-based medicine, chronic disease management, and complex clinical pathways.Skills:Exceptional clinical reasoning with the ability to synthesize complex patient data into well-supported decisions.Strong verbal and written communication skills for peer-to-peer reviews and interdisciplinary teamwork.High level of autonomy and self-motivation in a fully remote work environment.Why Join Us?Work-Life Balance: 100% remote flexibility while maintaining standard PST business hours.Expanded Impact: Apply your hard-earned medical knowledge to influence healthcare policy, quality standards, and Medicaid coverage on a broader scale.Interdisciplinary Reach: Engage regularly with physicians, healthcare leaders, specialists, and multidisciplinary care teams across diverse clinical domains.Meaningful Work: Directly support vulnerable populations by ensuring Medicaid members receive appropriate, medically necessary, and timely care.

Employee Benefits

Full-time candidates are eligible for a generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance.For additional information regarding this opportunity, please contact:Holly Benson Healthcare Recruiter, Judge HealthcareP: (610) 628-5496 | Ext: 9514 | E: hbenson@judge.com | judge.com