Physician Reviewer – UM Medical Director

🕒 February 2

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Medical Review Institute of America, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1983

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare Insurance • SaaS • Data

Medical Review Institute of America, LLC is a company specializing in clinical and utilization review services. They offer a comprehensive suite of data-driven solutions, including prior authorization optimization, second opinions, and specialty drug reviews, aimed at ensuring the right care is delivered at the right time and in the right place. MRIoA provides services to health plans, pharmacy benefit managers, government entities, and self-insured employers, among others. They leverage technology and a network of professionals to streamline clinical decisions, enhance provider performance, and ensure compliance with regulatory requirements across all 50 states. Their tools and platforms are designed to optimize clinical reviews, reduce costs, and improve patient outcomes through evidence-based care pathways and telehealth solutions.

📋 Description

• 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