Physician Reviewer

AltaMed Health Services

. Conduct routine reviews of authorization requests across all lines of business using applicable national/state health plans and recognized guidelines .

Posted 10/31/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $248,923 - $311,153 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting authorization reviews, processing denials, and providing case management for patients. Capable of interdisciplinary care coordination and training staff in utilization management practices.

Highest-signal resume keywords

MD/DOPhysician Training Program CompletedValid BLS CertificationBoard Certified PreferredAuthorization Review

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Authorization ProcessingDenial ManagementCase ManagementUtilization ManagementFinancial ReportingHigh-Cost Utilization AnalysisPatient ReferralInterdisciplinary Care CoordinationRecommendations on Retro ClaimsOversight and Guidance

Soft Skills

TrainingCollaborationCommunicationLeadership

Tools & Technologies

Authorization Platform

Certifications & Qualifications

BLS CertificationBoard Certification

Industry Keywords

Health PlansClinical GuidelinesHigh-Risk PopulationsOutpatient AuthorizationsInpatient AuthorizationsEmergency Room ClaimsCase Management ProgramsMental Health CounselingPsychosocial SupportHome Health Teams

About the role

Key responsibilities & impact

Conduct routine reviews of authorization requests across all lines of business using applicable national/state health plans and recognized guidelines
Approve authorizations according to delegation responsibilities, the AltaMed Authorization Matrix, training, and licensing restrictions
Process authorization denials using standard denial language and post recommendations in the authorization platform
Review and make recommendations on retro claims for outpatient authorizations, inpatient authorizations, and emergency room claims
Participate in ad hoc projects and analyze high-cost utilization, unmanaged care, inappropriate utilization, billing practices, and budgeting/financial reporting
Identify high-risk populations and refer patients to appropriate case management programs
Provide oversight, guidance, and training to UM nurse reviewers and other UM staff when applicable
Provide case management to hospitalized patients and patients needing ambulatory case management
Participate in interdisciplinary care coordination with social work, mental health counseling, psychosocial support, in-home support, legal services, skilled nursing, and home health teams

Requirements

What you’ll need

MD/DO
Physician Training Program completed
Graduation from an accredited medical training program
Valid BLS certification or higher, following American Heart Association (AHA) or American Red Cross guidelines
Board Certified preferred

Benefits

Comp & perks

Medical, Dental and Vision insurance
403(b) Retirement savings plans with employer matching contributions
Flexible Spending Accounts
Commuter Flexible Spending
Career Advancement & Development opportunities
Paid Time Off & Holidays
Paid CME Days
Malpractice insurance and tail coverage
Tuition Reimbursement Program
Corporate Employee Discounts
Employee Referral Bonus Program
Pet Care Insurance
Discretionary bonuses or incentives may apply