Physician Reviewer (Part Time)

Remote from: USA
Salary, yearly, USD: 300,000 - 340,000
Department: Healthcare & Medical
Employment type: Full Time,
Job posted: 6 Jun 2026
Apply before: 6 Jul 2026
Experience level: Midweight
Views / Applies: 23 / 3

Empowering Health at Home

Hospital & Health Care
1996

AI Summary

This part-time Physician Reviewer role involves conducting utilization reviews to determine medical necessity for post-acute care, home health, DME, and other services. The position requires an MD or DO with an active unrestricted license and board certification, along with at least 3 years of utilization management and clinical practice experience. The reviewer will collaborate with internal staff and external providers to support evidence-based care decisions. The role offers a consistent weekday schedule with flexibility and a high hourly pay rate. It is ideal for a physician seeking a focused, less patient-facing role in healthcare.

Role DNA

Job Complexity

Easy Hard

Pace & Pressure

Relaxed Fast-paced

Autonomy Level

Guided Full Ownership

Communication Load

Independent Highly Collaborative

AI Insight Requires an MD/DO degree, board certification, and specialized experience in utilization management and clinical practice, making it a challenging role that demands advanced clinical judgment and regulatory knowledge.

Salary Analysis

AI Insight The offered salary range of $300,000 to $340,000 per year is competitive and above the market median for physician reviewers, which typically ranges from $200,000 to $300,000. This provides an attractive compensation package.

Key Skills

Utilization Management Medical Necessity Review Board Certified MD/DO Evidence-Based Guidelines InterQual Milliman Criteria Healthcare Clinical Review Part-Time

Cover Letter Sample

Dear Hiring Team,

I am writing to express my strong interest in the Physician Reviewer (Part-Time) position at CareCentrix. With over 5 years of experience in utilization management and a board certification in internal medicine, I have developed a deep understanding of medical necessity reviews and evidence-based guidelines. I am particularly drawn to this role because it offers a flexible schedule while allowing me to apply my clinical expertise in a meaningful way. I am confident in my ability to meet SLAs and contribute to your team's success. Thank you for considering my application.

Possible Interview Questions

How do you handle a case where the clinical criteria do not clearly support medical necessity?

I would review additional documentation, consult with the ordering physician, and apply my clinical judgment while adhering to evidence-based guidelines and regulatory standards.

Describe your experience with InterQual or Milliman criteria.

I have used both InterQual and Milliman criteria extensively in my previous utilization management roles for over 5 years, and I am comfortable applying them to diverse clinical scenarios.

How do you manage time to meet SLAs in a part-time schedule?

I prioritize tasks efficiently, set dedicated review blocks, and communicate proactively with the team to ensure timely completion of reviews without compromising quality.

Can you give an example of a difficult determination you made?

Once, I reviewed a complex case involving a patient with multiple comorbidities where the guidelines were ambiguous. I consulted with the attending physician, documented the rationale thoroughly, and made a determination that balanced patient safety and policy requirements.

Why are you interested in a part-time physician reviewer role?

I value work-life balance and enjoy the focused, analytical nature of utilization review. This part-time role allows me to maintain clinical engagement while having flexibility for other professional or personal interests.

Overview

As a Part-Time Physician Reviewer, you will conduct utilization reviews to determine medical necessity across our different lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home Infusion Therapy, Sleep services.

In this role, you will collaborate, as needed, with internal staff, providers, and ordering physicians to support appropriate, evidence-based care decisions.

Position Details:• Title: Physician Reviewer (Part-Time, Permanent)• Pay: $150 to $170 per hour• Hours: 25 hours per week• Schedule: Consistent weekday schedule, between 8:00 a.m. and 6:00 p.m. EST, with flexibility to work additional hours as needed to meet business demands (including evenings, weekends, and holidays)

Responsibilities

Conduct medical necessity reviews for cases that may not meet established criteria and issue adverse determinations when appropriate
Evaluate requests across post-acute care services in alignment with clinical and regulatory standards
Meet or exceed Service Level Agreements (SLA) and performance guarantees required by health plan clients
Apply sound clinical judgment and maintain integrity in all determinations and interactions
Collaborate effectively with internal and external stakeholders, including providers and physicians
Perform other duties as assigned

Qualifications

MD or DO with an active, unrestricted medical license (in states aligned with CareCentrix client payer requirements)
Current and unexpired board certification in a relevant specialty
Minimum 3+ years of utilization management (UM) experience
Minimum 3+ years of clinical practice experience, including inpatient care
Experience using evidence-based clinical guidelines (e.g., Milliman/InterQual), as well as CMS and state-specific regulatory criteria, preferred

CareCentrix maintains a drug-free workplace

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.

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