Utilization Review & Case Management Specialist (Foreign-Trained Physicians Welcome, Will Train)We are seeking a foreign-trained physician to join our Utilization Review and Case Management team. This is a non-clinical role that puts your medical knowledge to work reviewing care for medical necessity, appropriateness, and efficiency, and helping patients move smoothly through the continuum of care. No prior utilization review or case management experience is required. We will provide full training on review criteria, payer guidelines, and U.S. healthcare workflows.
Requirements- Medical Degree: MBBS, MD, or equivalent from an accredited institution
- Medical Licensure: Currently or previously licensed to practice medicine in a country outside the United States
- Recent Clinical Experience: Direct clinical practice within the last 3 years
- Work Authorization: Must be authorized to work in the United States on a permanent basis. We are unable to sponsor or take over sponsorship of employment visas.
- Location: Must reside in the United States
- Language Proficiency: Good to excellent command of spoken and written English
- Professional Standards: Strong clinical reasoning, attention to detail, ethical judgment, and respect for patient confidentiality
Preferred Qualifications- Clinical experience in internal medicine, hospital medicine, or general practice
- Familiarity with U.S. healthcare, insurance, or EHR systems (not required; training provided)
- Exposure to InterQual, MCG (Milliman), or similar evidence-based criteria
- Located in the Pacific or Eastern time zone
- Strong written communication and comfort working with computers and multiple systems
Responsibilities- Review medical records to assess the medical necessity and appropriateness of admissions, continued stays, procedures, and services using established clinical criteria
- Summarize clinical information clearly and escalate cases that don't meet criteria to physician advisors or medical directors for determination
- Coordinate with nurses, social workers, attending physicians, and insurers to support timely, appropriate care and discharge planning
- Identify patients who may benefit from case management and help track care plans, barriers to discharge, and follow-up needs
- Communicate with payers regarding authorizations, reviews, and documentation requests
- Maintain accurate, timely documentation in accordance with regulatory, accreditation, and institutional standards
- Adhere to HIPAA and all applicable federal and state utilization review requirements
Training & GrowthOur structured training program covers utilization review criteria, Medicare/Medicaid and commercial payer rules, case management principles, and our documentation systems. This role can also be a strong foundation for certifications such as the CCM (Certified Case Manager) or HCQM, and offers valuable U.S. healthcare experience for physicians pursuing residency or other career paths.
