Physician Reviewer Job at The Judge Group, Richardson, TX

  • The Judge Group
  • Richardson, TX

Job Description

Advisor Medical Expert - Internal Medicine Physician

Location: 100% Remote (Continental U.S.)
Schedule: Monday-Friday, Pacific Time business hours
Licensure Required: Active California Medical License

Overview

Seeking a Board-Certified Internal Medicine or Primary Care Physician to support medical necessity reviews, appeals, utilization management activities, and complex case evaluations within government-sponsored healthcare programs. This fully remote position allows physicians to leverage their clinical expertise outside of direct patient care while influencing quality, access, and appropriate utilization of healthcare services.

Responsibilities
  • Review medical necessity determinations, prior authorizations, and appeals
  • Conduct peer-to-peer discussions with treating providers
  • Evaluate inpatient, outpatient, post-acute, and specialty care cases
  • Apply evidence-based medicine and clinical guidelines to decision-making
  • Provide clinical consultation to utilization management and care management teams
  • Assist with policy development, quality initiatives, and complex case reviews
Qualifications
  • MD or DO
  • Active, unrestricted California medical license
  • Board Certification in Internal Medicine, Family Medicine, or related primary care specialty
  • 5+ years of post-residency clinical experience
  • Strong background in evidence-based medicine and chronic disease management
  • Prior utilization management, payer, medical review, or Medicaid experience preferred
Highlights
  • Fully remote
  • No direct patient care
  • Influence healthcare quality and utilization decisions
  • Collaborative multidisciplinary team environment
  • Opportunity to impact Medicaid member care at scale
Ideal Candidate

This is likely a strong fit for:
  • Internal Medicine physicians
  • Family Medicine physicians
  • Hospitalists
  • Physicians currently performing utilization review, disability reviews, peer reviews, or health plan medical director work
  • Clinicians looking to transition away from full-time patient care while remaining clinically engaged

Job Tags

Full time, Monday to Friday

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