Physician Family Practice-Without OB - Competitive Salary

Company: RecruitWell
Location: Daytona Beach
Posted on: February 28, 2026

Job Description:

Job Description Daytona Beach, Florida, Utilization Review Physician Opening - Remote Position Do you know someone that might be a good fit for this position? Please ask about our generous referral fees! Overview: A large multi-specialty staff model HMO, is seeking a Utilization Management Physician (UMP). This full-time, remote position requires critical thinking skills, effective communication, and decisive judgement. The ideal candidate will have a working knowledge of the responsibilities listed. Clinical Role: Review pre-authorization requests, initial clinical review, and concurrent clinical review cases. Review post-service clinical decisions including claims and appeals.Render determinations based on relevant clinical information, medical necessity determined by using evidence-based medicine, nationally recognized criteria (i.e. MCG (formally Milliman), InterQual, Centers for Medicare and Medicaid), FHCP Protocols, and the Member’s FHCP Coverage Documents.Review clinical criteria and scripts at least annually and update if necessary.Assist the CMO in Provider education regarding treatment protocols, treatment options, etc., as appropriate.Be available to staff to answer questions regarding cases under review.Be available for peer-to-peer discussions of cases under initial or concurrent review either in person, by telephone, or electronically.Meet current regulatory standards regarding pre-authorization determinations.Be available to discuss urgent cases directly with attending provider.For non-certification decisions, specifies the principal reason for the determination not to certify and the clinical rationale for the non- certification.Consult with other physicians in medical specialty areas as needed.Participate in organization committees at the request of the CMO. Practitioner Requirements Practitioner must meet the following minimum requirements to serve as a Utilization Management Practitioner(“UMP”) for the organization: MD, DO, or PhD degree from an accredited medical school.Licensed to practice medicine in the state of Florida without restriction.Board certified in Internal Medicine or Family Medicine.Have three (3) to five (5) years clinical experience.Medical Review OfficerPhysician Adviser / Physician Reviewer Knowledge and experience with managed care health plan and benefitsAbility to provide medical knowledge to facilitate resolution of complex issues and required decisions.Working knowledge of medical policy and application of criteriaAgree to participate in the Interrater Reliability Tool or such other audit process employed by the organization to ensure consistent application of medical policy and coverage criteria.This is a remote role with in person visits to the Daytona Beach Area. Qualified applicants must be within a r easonable driving distance. Organization Information: Competitive salaryBonus opportunity401(K) Tax Deferred PlanHMO Health Benefits for provider & eligible dependentsGroup Term LifeGroup Disability · Malpractice InsurancePaid Leave TimeCME StipendLicenses, Fees & Dues reimbursed.Travel ReimbursementRelocation AssistanceComprehensive network of medical practices and services across FloridaCare Centers that combine doctors, pharmacies, labs, and urgent care under one roof for convenienceOver 9,000 in-network providers offering specialties such as internal medicine, family medicine, psychiatry, endocrinology, cardiology, general surgery, and moreStrong Referral Network Lifestyle Information: Live in a beautiful family-oriented area on Florida’s southeast coastAn abundance of stunning beaches, parks, and attractionsLive in one of Florida’s most popular destinations Enjoy a laid-back lifestyle where you can be outside year-round with access to great restaurants, shops, and moreNo state income taxIdeal Area for A Variety of Water Sports and Recreational ActivitiesConveniently Located to Major AirportsExcellent Public & Private Schools1 hour from Orlando1 hour from St. Augustine3 hours from Tampa4.5 hours from Miami RecruitWell's Core Values: Open communicationSense of urgencyTeamworkAccountabilityDriven to winHigher consciousness

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