Medicare Advantage Utilization Management Physician (SCAN Temp, Part-time)

The temporary Medicare Advantage Utilization Management Physician provides physician-level decision-making for prior authorization, concurrent review, and appeals programs. This role serves as the clinical authority for medical necessity determinations, conducts peer-to-peer discussions with treating providers, and partners with UM leadership to ensure timely, clinically sound, and cost-effective determinations. The position requires a local California-based physician with health plan UM experience, specifically in Medicare Advantage.