One of the most common nonclinical careers that we see physicians in our community pursuing are utilization management jobs. This can be quite controversial, with many members seeing it as “going to the dark side.” Instinctively, many practicing physicians associate utilization management with the many problems with prior authorization and insurance companies. However, for physicians choosing this non-clinical career option or side gig, this offers a work from home 9-5 type job which pays relatively well and for which they are able to use their medical knowledge and hopefully advocate for doctors and patients. Below, we’ll cover pros and cons of utilization management jobs and how to search for and get these opportunities, as well as red flags that tell you this job may not be for you.
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What Are Utilization Management / Utilization Review Jobs?
Utilization management jobs (also referred to as utilization review jobs) are jobs where physicians review requested treatments, diagnostic exams, or procedures and approve or deny them as necessary based on the patient’s clinical picture and history and their insurance policy. These may be prior authorizations for planned or requested procedures or be reviews of utilization in real time while a patient is admitted at the hospital (“concurrent reviews”). This may involve reviewing aspects of the patient’s hospital stay such as whether the level of care chosen is appropriate (ICU versus floor bed), length of stay, and whether continued hospitalization is necessary or whether the patient can be discharged or moved to a less urgent setting.
The job of the utilization management physician is to try and take an unbiased approach about whether the requested service is indicated, free of the bias of things like what a patient is asking for and like the time pressure of clinical work that may prevent you from being aware of the most recent guidelines about a particular workup.
This is a popular nonclinical job as there have been a lot of positions in recent years, the pay is in the 6 figure range and can be a full time job that allows you to leave clinical medicine, you don’t need many additional skills above what you already have as a physician, and most utilization management (UM) physicians work remotely.
Who Employs Utilization Management / Review Physicians?
Because insurance companies are regulated at the state level, there are jobs located throughout the country, with multiple positions existing with most insurance companies. Additionally, there are independent review organizations (IROs) who provide these services to various companies or establishments, and you can be hired by those as well.
While there may be others, the majority of UM jobs are with insurance companies, third party independent review organizations (IROs), and hospital systems.
You can see a list of independent review organizations on our chart review 101 page or by checking the The National Association of Independent Review Organizations (NAIRO) website.
What Does a Typical Job and Day of Work in Utilization Management or Review Look Like?
These positions tend to be 9-5, although some may require nights or weekends. Either way, the work life balance is quite good as you only work during your assigned hours. For physicians trying to get away from call, charting, checking lab results, and liability from potential lawsuits, many see utilization review as a way to get away from some of the more cumbersome parts of being a physician. Some physicians take full time positions whereas others have part time or otherwise flexible hours.
While roles may vary, common responsibilities include:
Reviewing patient charts, records, and documentation
Looking at treatment guidelines and protocols and researching indications
Doing peer-to-peer reviews / speaking with ordering physicians and other clinicians to assess appropriateness of the treatment plan
Putting in approvals or denials
If you are employed directly by the hospital instead of a payor or independent review organization, your job will be to reconcile the treatment plans with the patient’s insurance policy and hopefully prevent payments from being denied in the first place.
On a typical day, you are usually given a list of cases to review, which you go through in order. You may occasionally get interrupted by emails or phone calls, but most of the time utilization review physicians in our Physician Side Gigs group state that they are uninterrupted. Most reviews only take a few minutes. However, if there is a dispute about whether something should be covered or if needed for a prior authorization, the UM doctor will have to do a more thorough investigation or do a peer-to-peer via phone with the ordering physician and see if the requested service is in fact indicated.
Depending on the company you work for and the type of position you take, how much of each task you perform may vary. Averages are likely different amongst the different companies depending on the number of things they require prior authorizations for, what they tend to deny, and what’s covered in their plans.
Is a Utilization Management or Review Job Right for Me?
This is hard to say without knowing your goals. One thing we always emphasize for physicians looking to leave medicine is to run towards something, rather than away from something. We’ve seen many physicians switch to nonclinical work only to realize that it’s not for them. If possible, spend some time considering all of your options before deciding to quit clinical medicine.
Additionally, consider what your thoughts are about utilization management work. Understandably, many physicians have mixed feelings about this type of work as they have likely been on the other side of the prior authorization process in their clinical jobs, and know the frustrations of the system. Physicians thinking about taking these positions often voice that they’re worried about speaking with physician colleagues who may get upset with them if they have to deny something based on guidelines. Unfortunately, telling a group of physicians that this is what you do for a living will likely always be met with some cynicism by some, especially in today’s healthcare environment, so you will need to be okay with this.
On the other hand, though, you will get to know best practice guidelines and relevant research, and hopefully apply that knowledge in conjunction with your medical knowledge to advocate for when something makes sense (and when it doesn’t). The job could also offer you the ability to
review the insurance company’s policies and push to revise them if something doesn’t make sense, which could give you the ability to make positive changes in helping your colleagues and patients.
How Do I Find a Utilization Management or Review Job?
To find a job, you need to get outside of the mindset of a physician and shift more towards the rest of the working world’s job search process. This means:
Networking
Talk to other physicians who are in the space to really understand the job and whether it’s a good fit - these same physicians may know of openings at their companies and can put in a good word for you.
Create a LinkedIn profile - LinkedIn is a powerful networking tool and in addition to scouring jobs, you can network with people that work at companies or who may be willing to talk to you or help you in the process. With so many people applying for nonclinical jobs these days, your network is really key to your success. Paying for the Premium account may be helpful so you can send more messages to people who aren’t contacts. Learn more about LinkedIn and using it effectively.
You could consider going to relevant conferences.
Prepare Your Resume
Brush off your CV and convert it into a resume - As physicians, most of us have CVs that list everything we’ve ever done on them. Nobody in the nonclincal careers world wants to see these. They want to know if you’re a good fit for their job and you have less than a minute to prove it to them. Learn more about the differences between a CV and resume here.
Start Applying for Jobs
Look on job boards - Look at job sites like LinkedIn, Indeed, etc. Search under the terms ‘medical director,’ ‘utilization management,’ ‘utilization review,’ ‘physician reviewer,’ and ‘physician advisor.’ Some of these may yield non-UM jobs but it’s better to cast your net wide at first.
Go on insurance company and independent review organization (IRO) company websites - Above, we covered who tends to employ utilization management physicians. Look at the names of the specific companies on the NAIRO website and apply to as many of them as possible.
How Do I Make Myself More Competitive for a Utilization Management or Review Job?
As nonclinical jobs become more competitive secondary to changing physician demographics and increasing burnout, many of our members ask what they can do to get a leg up in the hiring process. Members of our physician communities currently in these positions echo general thoughts that candidates really have to demonstrate that they are interested. With so many physicians looking to leave clinical medicine, many companies have noticed that physicians are applying to any nonclinical job that they hear about, regardless of whether they know anything about it or if they would be a good fit. Therefore, our members say that the more you can show that you have a real reason to specifically be pursuing UM, the more likely the recruiters are to take your application seriously. They don’t want to put the effort into training someone only to find out that they will leave in a few months.
Some tips from our members:
Apply widely - As above, apply to every UM job you can see. They are competitive, so the chances of you getting the first one you apply to aren’t high.
Create a resume specific to each job you’re applying to - Tailoring your resume to that specific job with a good statement for why you are interested in it is going to get a lot more attention than something generic
Show some experience if possible - Many physicians do UM as a side gig before jumping over to full time.
Consider taking a ABQUARP course / exam - While almost everyone says these are unnecessary from the learning standpoint because most companies will train you on the job, having the certificate can show your sincere interest in moving into this space, as well as potentially some “experience.”
Keep an eye out for other physicians doing it and remind them that you’re looking from time to time - This way, if an opening comes up at their company, you’ll be top of mind.
Be persistent and know that it might take a while - It is what it is.
Conclusion
Utilization management side gigs or jobs are becoming more popular as more physicians look to switch to nonclinical careers. Once you determine that this job may be a good fit for you, realize that finding a utilization management job may take some research, networking, and persistence, but there are lots of them out there. Good luck!
Additional Resources for Doctors Seeking Nonclinical Jobs
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