ZipRecruiter

Log In

2

Part Time Medical Utilization Review Physician Jobs

Medix

Utilization Review Nurse

Southfield, MI · On-site

$42 - $46/hr

Job Summary Our client is seeking a Utilization Review Nurse to manage the full lifecycle of ... medical records. * Perform quality assurance on physician reports to ensure accuracy, clarity ...

Providence Service

Utilization Review RN

Portland, OR · On-site

... part time and full-time opportunities for day shift. The RN Coordinator-Utilization Review supports ... Five (5) years Clinical experience in an acute adult medical/surgical care setting, OR Five (5) ...

Valenz

Medical Director - Part Time

Phoenix, AZ · Remote

As the Part-Time Medical Director, you'll provide physician leadership for the organization's medical management and utilization review programs. You'll help ensure clinical decisions, medical ...

Providence Service

Utilization Review RN

Portland, OR · On-site

... part time and full-time opportunities for day shift. The RN Coordinator-Utilization Review supports ... Five (5) years Clinical experience in an acute adult medical/surgical care setting, OR Five (5) ...

Valenz Health

Medical Director - Part Time

Phoenix, AZ · On-site +1

As the Part-Time Medical Director, you'll provide physician leadership for the organization's medical management and utilization review programs. You'll help ensure clinical decisions, medical ...

next page

Showing results 1-20

All Jobspart time JobsHealthcare JobsNursing JobsNurse Case Manager JobsPart Time Medical Utilization Review Physician Jobs

Part Time Medical Utilization Review Physician information

See salary details

$41.5K

$233.5K

$315.5K

How much do part time medical utilization review physician jobs pay per year?

As of Aug 30, 2026, the average yearly pay for part time medical utilization review physician in the United States is $233,521.00, according to ZipRecruiter salary data. Most workers in this role earn between $220,000.00 and $261,000.00 per year, depending on experience, location, and employer.

What is a part time medical utilization review physician?

A Part Time Medical Utilization Review Physician is a licensed medical doctor who reviews medical records, treatment plans, and healthcare services to ensure they are medically necessary and meet established guidelines. This role is often performed remotely and on a part-time basis, allowing physicians to balance other clinical or personal commitments. Utilization review physicians help insurance companies, hospitals, or healthcare organizations make decisions about patient care, coverage, and resource allocation. They do not provide direct patient care but play a vital role in promoting quality and cost-effective healthcare.

What are the typical responsibilities and workflow for a part time medical utilization review physician?

As a part-time Medical Utilization Review Physician, your primary responsibilities involve evaluating the medical necessity, appropriateness, and efficiency of healthcare services requested for patients. You will review clinical documentation, apply evidence-based guidelines, and collaborate with case managers and other healthcare providers to make determinations on pre-authorizations and appeals. The workflow is often remote or office-based, structured around scheduled case reviews, with flexibility to accommodate part-time hours. Effective communication, time management, and staying current with clinical guidelines are essential to succeed in this role.

What are the key skills and qualifications needed to thrive as a part time medical utilization review physician?

To thrive as a Part Time Medical Utilization Review Physician, you need a valid medical degree (MD or DO), active state licensure, board certification, and extensive clinical experience. Familiarity with utilization management software, electronic health records (EHR), and knowledge of insurance guidelines and medical necessity criteria (such as MCG or InterQual) are typically required. Strong analytical thinking, attention to detail, and effective written communication are vital soft skills for success in this role. These skills ensure accurate medical reviews, compliance with regulations, and efficient healthcare resource management.
More about Part Time Medical Utilization Review Physician jobs

What cities are hiring for Part Time Medical Utilization Review Physician jobs?

Cities with the most Part Time Medical Utilization Review Physician job openings:

What are the most commonly searched types of Medical Utilization Review Physician jobs?

The most popular types of Medical Utilization Review Physician jobs are:

What states have the most Part Time Medical Utilization Review Physician jobs?

States with the most job openings for Part Time Medical Utilization Review Physician jobs include:

What job categories do people searching Part Time Medical Utilization Review Physician jobs look for?

The top searched job categories for Part Time Medical Utilization Review Physician jobs are:

Part Time Medical Utilization Review Physician jobs near you
Infographic showing various Part Time Medical Utilization Review Physician job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $233,521 per year, or $112.3 per hour.

Senior Utilization Review Specialist - Part Time

Sage Clinical RCM, LLC

Gulfport, FL • On-site

Part-time

Posted 8 days ago

Job description

Description: Position Summary

The Part Time Senior Utilization Review Specialist is an experienced registered nurse responsible for concurrent and retrospective review of hospital services to support appropriate utilization, accurate patient status, timely payer authorization, and medical necessity compliance. This senior individual-contributor role serves as a clinical resource for complex cases and partners with physicians, care management, patient access, coding, and revenue cycle teams to reduce avoidable denials and support appropriate reimbursement.

Key Responsibilities

• Perform concurrent and retrospective utilization review for assigned inpatient, observation, and outpatient cases using approved criteria, payer policies, and clinical judgment.

• Apply InterQual, MCG, or client-approved criteria to support medical necessity, level of care, continued stay, and patient-status determinations.

• Obtain, submit, and track payer notifications and authorizations; communicate clinically relevant information to payer medical-management teams within required time frames.

• Identify potential medical-necessity, authorization, status, and documentation risks early and escalate appropriately to prevent avoidable denials.

• Collaborate with physicians, case management, CDI, coding, patient access, and revenue cycle partners to clarify documentation and support appropriate care progression.

• Coordinate clinical information and deadlines for peer-to-peer review or denial escalation when needed; maintain complete, accurate documentation in the designated systems.

• Serves as a member of the Utilization Review Committee-prepares reports to include utilization trends, denial patterns, extended stays, and workflow barriers; communicate actionable findings to leadership.

• Performs escalations to UR Committee members to ensure that compliance with regulations for patient status changes by providers are occurring per policy. Documents escalations and presents outcomes to UR committee.

• Serve as a senior clinical resource, providing guidance and support on complex review questions while adhering to established policies and escalation pathways.

• Participate in quality audits, education, process improvement, and other initiatives that strengthen utilization management performance.

Requirements: Required Qualifications

• Current, unrestricted RN license.

• Five or more years of acute-care hospital experience, including at least three years in utilization review, utilization management, case management, or a closely related function.

• Demonstrated experience applying medical-necessity and level-of-care criteria, including concurrent review and continued-stay review.

• Working knowledge of inpatient versus observation status, payer authorization requirements, Medicare and managed-care utilization principles, and denial-prevention practices.

• Strong clinical judgment, prioritization, documentation, communication, and collaborative problem-solving skills.

• Ability to independently manage a high-volume, deadline-driven caseload while exercising sound judgment regarding escalation.

Preferred Qualifications

• Bachelor of Science in Nursing (BSN).

• Certification in case management or utilization management, such as CCM or ACM.

• Experience with InterQual, MCG, Cerner, or comparable utilization-management and electronic health-record systems.

• Experience supporting hospital denials management, peer-to-peer coordination, or care-progression initiatives.


Role Boundaries and Work Expectations

• This is a senior individual-contributor role and does not include direct people management unless separately assigned.

• The specialist follows St. John's Health clinical policies, payer requirements, and established Sage Clinical RCM workflows.

• The role requires discretion with protected health information and strict compliance with HIPAA, client security standards, and applicable regulations.

• Availability during agreed hospital business hours and participation in required meetings, education, and workflow updates are expected.