Utilization Management Physician Reviewer - Remote

Overview

The Utilization Management Physician Reviewer at CVS Health is responsible for making accurate coverage determinations for healthcare services, ensuring patients receive medically appropriate care.

In Short

• Full-time remote position.
• Responsible for coverage determinations for inpatient and outpatient services.
• Collaborate with care teams to ensure effective care delivery.
• Maintain compliance with legal and regulatory requirements.
• Use evidence-based criteria for decision making.
• Participate in quality improvement initiatives.
• Document decision rationales clearly.
• Fulfill on-call requirements as needed.
• Must have a current medical license in the U.S.
• 3-5 years of clinical practice experience required.

Requirements

• Experience in Utilization Management services.
• Excellent verbal and written communication skills.
• Graduate of an accredited medical school (M.D. or D.O.).
• Deep understanding of managed care and care coordination.
• Strong organizational skills and attention to detail.
• US work authorization required.
• Commitment to culturally responsive care.
• Record of continuing education in relevant fields.

Benefits

• Competitive pay and comprehensive benefits.
• 401(k) plan with company matching.
• No-cost wellness programs and counseling services.
• Flexible work schedules and paid time off.
• Tuition assistance and family leave options.
• Employee stock purchase plan.
• Support for physical, emotional, and financial wellness.