Medical Review Institute of America, LLC

Physician Reviewer – UM Medical Director

Medical Review Institute of America, LLC

full-time

Posted on:

Location Type: Remote

Location: United States

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Job Level

Lead

About the role

  • Conduct utilization and medical necessity reviews using benefit language, medical policies, and evidence-based guidelines
  • Apply benefit interpretation to ensure accurate, compliant, and well-supported determinations
  • Prepare detailed documentation that meets regulatory, accreditation, and internal quality standards
  • Participate in peer-to-peer conversations with treating clinicians when required
  • Work collaboratively with Medical Directors across regions and specialties to support consistent clinical decision-making

Requirements

  • Hold an active, unencumbered state licensure as a Medical Doctor (MD/DO), any state.
  • Hold current board certification in either Family Medicine or Internal Medicine (no other board-certified specialty is currently needed).
  • Possess a minimum of 5 years of direct patient care experience, with the most recent experience no less than 6 months ago (recent clinical care is essential).
  • Have recently (within the past 2 years) work in an inpatient/hospital setting.
  • Highly skilled with a variety of computer software programs (will be trained on many).
  • Be willing to obtain up to 20 additional state licenses (MRIoA covers the cost of licenses and CME requirements to maintain them).
  • Have a clean background, without prior licensure issues, pending malpractice cases or legal issues.
  • Possess excellent verbal and written communication skills.
  • Excellent interpretation skills, divergent/creative thinking skills.
Benefits
  • Medical, dental, and vision insurance
  • 401(k) plan with generous employer matching
  • 35 days of paid time off annually
  • All required computer equipment provided
  • Opportunity to join a stable, well-established organization with long-standing industry credibility
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
medical necessity reviewsbenefit interpretationdocumentation preparationclinical decision-makingdirect patient careinpatient care
Soft Skills
verbal communicationwritten communicationinterpretation skillsdivergent thinkingcreative thinking
Certifications
Medical Doctor (MD/DO)board certification in Family Medicineboard certification in Internal Medicine