Utilization Management Physician Reviewer

UM Physician Reviewer in Los Angeles and Orange County offering the ability to work remote and make over $275,000 a year

Los Angeles, CA 90040
Income Potential:
Up to $256,000.00*
Signing Bonus:
Loan Forgiveness:
Job Number:
Posted Date:
Recruiter's Name:
Zachary Robertson
Contact Number:
Merritt Hawkins

Job Description & Requirements
Start Date:
Available Shifts:
90% to 100% remote (only required to report to work for meetings
Job Type:

Join a team that truly lives to “eliminate disparities in healthcare access and outcomes by providing superior quality health and human services through an integrated world-class delivery system.” A statement they don’t take lightly. They have invested millions in the latest technologies to help ensure their patients have access to the most advanced treatments in Los Angeles and Orange County for the last 48 years with 35 locations. The incoming provider will be welcomed into newly renovated clinics offering state-of-the-art technology, equipment, and always giving back to the community.
  • 100% non-clinical (90% to 100% remote, only required to report to the corporate office during quarterly meetings)
  • Must be board certified and maintain an active CA medical license
  • Will provide routine review of authorization requests from all lines of business using respective national/state, health plan, nationally recognized guidelines where appropriate to provide guidance for processing of referrals to Medical Director staff and to UM staff
  • Responsible for the daily review and processing of referral authorizations in accordance to TAT standards
  • Will process denials of authorizations using standard denial language and post recommendations in the authorization platform to inform Medical Director inflow
  • Works collaboratively with hospitalists, hospital partners, and care teams to provide holistic patient care that is focused on high quality in a cost effective way
  • Monitors ongoing services and their cost effectiveness; recommending changes to the plan as needed using clinical evidence-based criteria
  • Participate in ad hoc projects and analysis of high cost utilization areas, unmanaged care, inappropriate utilization, inappropriate billing practices, and budgeting/financial reporting
  • Will participate in the developing of all program materials, policies, and procedures related to the medical management, including the development of informational and educational materials
  • Salary up to $256,000 based on experience plus annual physician incentive bonus
  • Comprehensive benefits including full medical, dental, vision, and 403b with a 4% employer contribution and 457f with an additional $20,000 added to your 403b
  • 17 days of PTO (PTO increases with tenure) and 1 week of CME with $3,000
  • Additional discounts on all amusement parks including Disneyland, movies, cell phone providers, and the metro link
  • Student loan reimbursement program

Our community is located in the heart of Los Angeles and Orange County, where you will find a harmonious mix of cultures and traditions which adds a great richness and history to the communities. The intermingling of these cultures and traditions results in a sense of respect and civility toward one another—making this community a great place to live, play, and work.
  • Coastal community with over 300 days of sunshine and a moderate year-round climate 
  • Disneyland and Huntington Beach in your backyard
  • Unbeatable access to outdoor activities—hiking, biking, golfing, tennis, fishing, camping, and more
  • Home to many professional sports teams, easy access to Temecula Wine Valley, Yosemite National Park, Joshua Tree National Park, and Griffith Park
  • Excellent school options for your children with both public and private schools
  • Multiple universities, medical schools, and residency programs
  • Access to an international airport for easy travel

About The Company

Merritt Hawkins, an AMN Healthcare company, is a permanent physician placement service that fills more physician jobs than any other firm. In addition to being the nation’s leader in physician employment search and consulting services, Merritt Hawkins also recruits and places select allied health professionals. AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer.  We encourage minority and female applicants to apply.