In this non-clinical utilization management role, the clinician reviews invasive and interventional cardiology cases, including cardiac catheterizations, coronary interventions, endovascular procedures, and implantable cardiac devices, to determine medical necessity and support high-value care decisions. The work also includes peer-to-peer discussions with ordering and treating providers, appeal support, and documentation of review determinations. Collaboration with physicians, leadership, and clinical staff is central, and the role is fully remote with flexible part-time or full-time options.
Key Responsibilities
- Provide specialty-matched reviews for interventional cardiology cases that require further medical necessity assessment.
- Conduct peer-to-peer discussions with treating and requesting providers to support evidence-based decisions.
- Coordinate with leadership, management, and clinical staff on complex cases and utilization management decisions.
- Serve as a resource for initial clinical reviewers and help guide best-practice application.
- Provide clinical rationale for standard and expedited appeals.
- Document communications and review outcomes accurately and in a timely manner.
- Use medical review guidelines and parameters to support consistent, compliant utilization review.
- Participate in ongoing training and inter-rater reliability review processes.
Required
- MD, DO, or MBBS degree.
- Current unrestricted clinical license in medicine or the required specialty.
- Ability to obtain and maintain required state medical licenses based on business needs.
- Active board certification in Interventional Cardiology, or active board certification in Cardiology with prior board certification in Interventional Cardiology or active interventional cardiology practice for 5+ years.
- At least 5 years of cardiology practice experience preferred by the employer as a qualification benchmark.
- No current exclusion, sanction, or major disciplinary/legal action by a medical board.
Preferred
- At least 5 years of experience practicing cardiology.
- Strong clinical, communication, management, and organizational skills.
- Computer proficiency.
- Interest in quality, value-based care, and utilization management.
Benefits & Perks
- 100% remote work from any state.
- Flexible schedule options.
- Part-time and full-time options available.
- Comprehensive benefits package, including health insurance for qualifying employees.
- Base pay range of $120-$140 per hour.