Utilization Reviewer – Medical Doctor

About the role

The Utilization Reviewer – Doctor is responsible for evaluating medical services to ensure they are appropriate, medically necessary, and of high quality. This role involves detailed review of patient records, application of clinical guidelines, and preparation of comprehensive reports.

Key responsibilities

• Assess delivery of medical services against client‑specific guidelines and templates.
• Abstract, analyze, and document medical records, identifying missing information and ensuring completeness.
• Apply ACOEM guidelines and evidence‑based references to certify or refer procedures for peer review.
• Prepare impairment and disability determinations in line with AMA Guides, PDRS, and Social Security requirements.
• Conduct disability reviews, research, deposition audits, and rating of IME, FCR, QME, AME, and P&S reports.
• Coordinate with the Production Supervisor and fellow reviewers on job assignments and production targets.
• Submit accurate reviews within specified timeframes and meet quality and quota standards.

Required profile

• Graduate of Medicine (licensed or non‑licensed).
• Excellent oral and written communication skills.
• Willingness to work onsite at Upper McKinley, Taguig.

Required skills

• Knowledge of ACOEM guidelines, AMA Guides to the Evaluation of Permanent Impairment, and PDRS.
• Experience with medical records abstracting and utilization review processes.

What we offer

• Opportunity to work within a multidisciplinary team focused on high‑quality medical review.
• Professional development in utilization review and disability assessment.