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Utilization Management Physician Reviewer Jobs (NOW HIRING)

Tango Care

Physician Reviewer (Remote)

Phoenix, AZ · Remote

The Physician Reviewer is in a utilization management reviewer role at tango - providing UM case reviews, peer to peer calls/conversations and consultations in real-time; assisting as a resource with ...

ChenMed

Pain Management Physician

Miami, FL · On-site

The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in our organization. Other duties include advising other physician reviewers and attending daily calls ...

New

Covenant Health

RN UTILIZATION MGMT I

Knoxville, TN · On-site

... physician reviewer those that require additional expertise. * Maintains accurate records of all ... Collaborates with payor utilization management liaisons and medical directors as applicable.

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is a nationally recognized, URAC-accredited ... utilization review, or expert medical opinions. Why Partner with MMRO? * 100% remote independent ...

Managed Medical Review Organization

About MMRO Managed Medical Review Organization (MMRO) is a nationally recognized, URAC-accredited ... utilization review, or expert medical opinions. Why Partner with MMRO? * 100% remote independent ...

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Utilization Management Physician Reviewer information

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How much do utilization management physician reviewer jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization management physician reviewer in the United States is $37,992.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,000.00 and $42,000.00 per year, depending on experience, location, and employer.

What does a utilization management physician reviewer do?

A Utilization Management Physician Reviewer is a licensed physician who evaluates the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and hospital admissions. They review patient records and clinical information to ensure that care meets evidence-based guidelines and payer requirements. Their decisions help manage healthcare costs while ensuring patients receive necessary treatment. These professionals often work with insurance companies, hospitals, or managed care organizations.

What are the key skills and qualifications needed to thrive as a utilization management physician reviewer?

To thrive as a Utilization Management Physician Reviewer, you need a valid medical degree (MD or DO), clinical experience, and licensure, often supplemented by board certification. Familiarity with utilization review guidelines, InterQual or MCG criteria, and electronic health record (EHR) systems is typically required. Strong analytical thinking, attention to detail, and effective communication help reviewers collaborate with providers and interpret complex medical data. These skills are crucial to ensuring appropriate, cost-effective patient care while adhering to regulatory and payer requirements.

What are the typical challenges faced by a utilization management physician reviewer, and how can they be addressed?

Utilization Management Physician Reviewers often encounter the challenge of balancing clinical judgment with payer policies and guidelines. They must make objective decisions about medical necessity, which can sometimes conflict with providers' recommendations or patient expectations. Effective communication and staying current with evolving healthcare regulations are crucial to address these challenges. Additionally, collaborating closely with multidisciplinary teams helps ensure thorough, fair reviews and fosters a supportive work environment.

What is the difference between Utilization Management Physician Reviewer vs Utilization Management Nurse Reviewer?

AspectUtilization Management Physician ReviewerUtilization Management Nurse Reviewer
CredentialsMedical degree, medical license, often board-certifiedNursing license, RN certification, possibly case management certification
Work EnvironmentHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare organizations, case management teams
Primary ResponsibilitiesReview medical necessity, approve or deny services, interpret clinical dataAssess patient records, review care plans, evaluate medical necessity from nursing perspective

While both roles involve reviewing healthcare services for appropriateness, the Utilization Management Physician Reviewer primarily makes decisions based on medical expertise and clinical judgment, whereas the Utilization Management Nurse Reviewer focuses on nursing assessments and care coordination. Both roles are essential in ensuring appropriate healthcare utilization within insurance and healthcare settings.

How to become a utilization management physician reviewer?

To become a utilization management physician reviewer, candidates typically need a medical degree, a valid medical license, and experience in clinical practice. Additional certifications such as board certification in a relevant specialty and knowledge of healthcare policies and coding can enhance qualifications. Familiarity with utilization review processes and documentation is also important.
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Utilization Management Physician Reviewer jobs near you
Infographic showing various Utilization Management Physician Reviewer job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 14% Part Time, and 2% Contract. Highlights an 89% Physical, 2% Hybrid, and 9% Remote job distribution, with an average salary of $37,992 per year, or $18.3 per hour.

Physician Reviewer - Psychiatry (Utilization Review)

Dane Street, LLC

New York, NY • Remote

Contractor

Re-posted 17 days ago

Job description

Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers. We are currently seeking Board-Certified Psychiatrist with an active New York medical license and Workers’ Compensation Board Certification to conduct Utilization Reviews.

This is a fully remote, non-clinical role offering supplemental income with flexible scheduling. Physicians provide objective, evidence-based opinions on the medical necessity of treatment requests and appeals. No patient contact, no treatment, and no doctor-patient relationship is established.

Key Responsibilities:

  • Review medical records to determine the medical necessity of services
  • Utilize state-specific workers’ compensation guidelines and nationally recognized criteria
  • Submit clear, concise, and well-supported determinations
  • Complete reviews within required timeframes (typically 1–5 business days)
  • Participate in peer-to-peer calls as needed (coordinated by Dane Street)
  • Complete addenda when new information is provided

Role Highlights:

  • Independent contractor (1099) status
  • Average case takes 15 minutes or less
  • Flat rate per case – consistent, supplemental income
  • Fully remote – work from anywhere
  • You control volume and availability
  • No direct patient interaction or treatment
  • Chronological, pre-organized medical records provided
  • User-friendly portal and streamlined case management
  • Full onboarding and ongoing support included

Requirements:

  • Board Certification in Psychiatry
  • Active, unrestricted New York medical license
  • Workers’ Compensation Board Certification (New York)
  • Active clinical practice

About Dane Street:
Dane Street is a national leader in Utilization Review and Independent Medical Review services. We partner with highly qualified, actively practicing physicians to ensure high-quality, evidence-based clinical decisions that support better outcomes across the healthcare system.

Apply today to join our Physician Review Panel and start earning on your schedule.