Introduction: Utilization Review (UR) Jobs for Physicians
The single most common non-clinical career transition for physicians is to go into one of the many available utilization review (UR) jobs for physicians. These jobs are plentiful, exist throughout the country, and are mainly remote based these days. The purpose of UR physicians is to approve or deny requested services based upon information in the insured’s chart and occasionally also a call with the treating physician (called a peer-to-peer call). The skills required for a non-clinical position in utilization review (reviewing and analyzing medical records) are therefore readily transferrable from clinical medicine.
Location: Utilization Review (UR) Jobs for Physicians
Every health insurer needs physicians to perform utilization review (UR). One of the nice things about insurance companies is that they are located all over the country. Some other industries tend to be located in a few areas. For example, jobs in financial services tend to be in New York, Boston, and Charlotte. Jobs in pharma tend to be concentrated in the Northeast, California, and a few other areas. Health insurance companies, however, are regulated and licensed on a state-by-state basis and have positions for physicians throughout the country.
Work from Home/Remote Utilization Review (UR) Jobs for Physicians
One of the great things about utilization review jobs for physicians is that most of these positions are currently remote/work from home. UR jobs for physicians are well-suited for work from home because of the nature of the work – reviewing medical records, doing some research, speaking on the phone with providers, and writing brief approvals or denials. So if you are looking for a work from home non-clinical career, utilization review could be a great fit.
Utilization Review (UR) Jobs for Physicians: Lifestyle
Utilization review jobs for physicians allow a very desirable lifestyle. There is no call. Hours are either set or flexible. In any event the weekly hours are reasonable. There are also no malpractice suits as there is no doctor-patient relationship with the insured.
Utilization Review (UR) Jobs for Physicians: Practice Setting
Utilization Review jobs for physicians are typically with either health insurers or independent review organizations. (IROs)
Health Insurers Utilization Review Jobs for Physicians: There are innumerable non-clinical utilization review positions for physicians in health insurance organizations. These include both part-time and full-time positions as well as independent contractors (1099).
Here’s a sample job posting for an entry-level non-clinical utilization review job at a health insurance company:
Medical Director Associate
Description: The medical director associate will be a member of the clinical leadership team. The individual will provide day-to-day guidance, support, and leadership for the clinical and quality activities. Essential duties may include, but are not limited to:
- provides support to nurse care managers in daily tasks
- performs utilization management review (prior authorization, appeal and grievance review)
- participates in peer-to-peer discussions
- identifies opportunities for improved quality of care
- reviews medical policy and technology assessments
- assists with implementing QI initiatives
- supports practitioner/provider credentialing
- performs other duties as assigned
Qualifications
- MD or DO with board certification required
- 5 or more years clinical experience
- Excellent oral and written communication required
- Demonstrated effective negotiation and leadership skills required
- Excellent interpersonal skills required to interact with all levels of associates and customers
Utilization Review Jobs for Physicians with Independent Review Organizations: Independent review organizations (IROs) exist to perform utilization reviews for other organizations such as insurance companies. IROs employ non-clinical utilization review physicians as both independent contractors and full- and part-time employees. Signing up first as a contractor performing peer reviews for an IRO is an excellent strategy to see how you would like utilization review and to also gain and demonstrate experience in the field. If you would like to do contract work, contact the IRO and ask to be placed on their panel. Fees for contract work typically range from $85–$110/hour (potentially more). The work can be done from home in most cases. Note that most IROs will want you to continue “in active practice” (at least part-time) for you to be eligible to do contract peer reviews. SEAK’s National Directory of Medical File Review Consultants is an excellent resource for physicians who wish to do work from home utilization review for IROs.
Here’s an entry-level utilization review job posting from an IRO so that you can get an idea of the type of work involved:
Medical Director
Job Responsibilities
Position Summary: This position is responsible for managing the medical review activities of the [employer].
Essential Functions:
40% directs medical review activities of the organization. Conducting critical peer reviews to ensure healthcare given is appropriate and necessary. Instructs other physician reviewers on critical reviews and improvement of healthcare.
30% assists [employer] staff with training physician reviewers regarding their responsibilities and functions. Serves as a technical expert on the peer review process.
20% represents [employer]’s policies and procedures to medical and non-medical persons. Participates in committee meetings representing the company.
10% performs miscellaneous duties as assigned.
Minimum Education & Other Requirements
Requirements:
Current medical license.
Positions working on specific contracts may require U.S. Citizenship.
Because of the nature and immediacy of the work, the ability to maintain regular and predictable attendance is essential.
Utilization Review (UR) Jobs for Physicians: Pay/Compensation
Entry level utilization review (UR) jobs for physicians typically pay the same or more than what primary care physicians earn. However, since there is no call, little stress, no malpractice risk, etc., utilization review physicians are in essence paid more to work less.
Conclusion: Utilization Review (UR) Jobs for Physicians
The most common non-clinical career transition for physicians is going into utilization review. These positions exist all over the country, are mainly work from home, and pay competitively. Both health insurers and independent review organizations have large numbers of utilization review jobs for physicians available.
James J. Mangraviti, Jr. is the co-founder of SEAK, Inc.’s annual Non-Clinical Careers for Physicians Conference, held each year in Chicago. SEAK’s Non-Clinical Careers for Physicians Conference features a faculty of dozens of physicians who have experience in non-clinical and alternative careers. Many of our faculty are SEAK alumni. SEAK’s Non-Clinical Careers for Physicians conference also includes free 1-1 peer mentoring, the opportunity to interview with employers and recruiters, and a robust networking experience. Jim can be reached at 508-457-1111 or jim@seak.com.