Presentation by John Jurica – Episode 449
In today's presentation, John provides a short overview of Physician Utilization Management Jobs.
John worked as a UM physician advisor himself and has interviewed several guests doing this full-time job.
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Why UM Appeals
The biggest draw is lifestyle: predictable hours, little to no weekend or holiday work, and fully remote setups in many payer roles. John also explains why the work feels lighter than clinical practice—structured criteria, no patient encounters, and no malpractice exposure, while still using medical training for decision-making and peer-to-peer discussions when needed.
- why utilization management matters,
- what physicians typically earn in UM roles,
- why your clinical training is important,
- what the day-to-day work looks like,
- the difference between hospital- and payer-based UM,
- and a proven path to your first full-time UM job.
How to Break Into Physician Utilization Management Jobs
The most reliable entry route starts with part-time reviews through independent review organizations, then leveraging that experience into hospital-based physician advisor roles or full-time payer positions. John explains why volume and timing matter when applying (fresh applications get seen) and why a resume beats a CV in nonclinical hiring.
He advises listeners to look for part-time opportunities at Independent Review Organizations (IROs) through the National Association of Independent Review Organizations (NAIRO.org). Once physicians acquire enough experience in part-time remote positions, they can seek permanent full-time postings on online job boards such as Indeed, on LinkedIn, and on healthcare insurer career pages.
Summary
The utilization management field remains one of the clearest paths to a stable, remote nonclinical job. If you treat the search like a process and show up consistently with the right resume and application strategy, success will follow.
NOTE: Look below for a transcript of today's episode.
Links for Today's Episode:
- How To Secure Your First Utilization Management Job
- Proven Path to a Remote Utilization Management Career
- Revisiting Why Utilization Management Physician Advisor Is a Great Hospital Job
- How to Pursue a Nonclinical Career in Hospital Management – 080
- The Truth About Medical Specialists and UM Jobs
- National Association of Independent Review Organizations
- Remote Careers for Physicians Facebook Group
- Nonclinical Career Academy
- 19 Presentations from the 2023 and 2024 Nonclinical Summits
Download This Episode:
Right Click Here and “Save As” to download this podcast episode to your computer.
The Amazing Truth About Utilization Management Jobs
You're listening to Physician Nonclinical Careers, episode number 449, the Amazing Truth About Physician Utilization Management Jobs.
Welcome back, nonclinical Nation. Today I am trying something new. And if it works, I'll replicate it. In future episodes, I'm going to take what I've learned about a particular career presented here over the past nine years and boil it down to a 20 minute or so presentation.
I hope to provide you an understanding of what the job entails, the pros and cons of choosing such a career, including the income that you generate and how to pursue it. One of the most popular options and one that has been addressed by at least six of my guests is the one I chose for today, and that's a career in Utilization Management.
Alright, today's topic, as I mentioned earlier, is the amazing truth about physician utilization management jobs.
Now let's look at the first slide here, and here's our agenda. basically this is how we're going to spend the next 20 minutes. we'll start with a quick overview. dive deep into some common themes that emerged from my own experience as a physician advisor for utilization management and my guests.
I will look honestly at a few differences and contradictions. Finish the exact steps you can take starting tomorrow. So, this will be a quick overview, but I think we'll hit the high points and, In just a very short time, explain why you should consider doing this job, why you shouldn't, what it's like and the steps to take to, to pursue this job.
So why does utilization management matter? Well, this is not a new thing. It's been around for years. In fact, I did this kind of job, I think almost 30 years ago, and everybody that I've interviewed, and if you just read about this, you'll find that, Basically, it's a process to make sure that patients get the right care in the right setting while controlling unnecessary cost and waste.
And it's, falls into different categories. There's prior authorizations. This can be outpatient or inpatient, concurrent reviews and retrospective reviews. And sometimes you're brought in for other things as well. And there's basically three main employer types. There's all the insurance companies I'm sure you're well aware of if you're dealing with them either in your office or at the hospital setting.
If you're in either of those settings. Hospital systems. That's where I started. I never did work for an insurance company, but my colleagues have. And, what's called an IRO, stands for Independent Review Organizations. So these are the ones that typically employ the part-time people to fill in for special things, for certain types of reviews, and,
The nice thing about the IROs is that they can serve as a training ground where you're still working your original clinical job, if that's what you're doing, and then segue into the more permanent full-time job. So, it's pretty straightforward how this works. There have been thousands and thousands of physicians that have done this, and we'll talk in a minute about why they've done it and how they've done it.
Okay. So the key themes here, we're going to talk about lifestyle. That's the thing. Lifestyle is really the major thing. Driving people to utilization management. So the ideal job, let's say you're working for an insurance company, is it's generally fully or mostly remote, but you can become fully remote for sure.
It's rare that you have to drive into an office to do these things 'cause they're all, all the reviews are done remotely. the, the. Time to work on this. Typically full-time, 35, 40 hours a week, no call, no medical records, and you have a salary. And if for some reason the week is slow because they don't have enough reviews for you to do, you get paid the same.
There's no on-call responsibilities. There's no nights, no weekends, no holidays. In general, you could probably find a rare situation where somebody needs an emergency review because of a hospitalized patient that may need to get a procedure or surgery or something. So you might have one person, in a large department available for those acute requests, but they're pretty rare and basically compared to medical practice the stress is much lower. It's a comfortable pace, and, you're not legally responsible in terms of any kind of liability for what happens. You don't have to have malpractice insurance if you're no longer seeing patients as a practicing physician, and, you don't actually interact with the patients.
I don't think ever.
So everybody that I've talked to, all my guests agreed this was the scenario, and that's why it's very attractive.
Now, how about the compensation? Here are the numbers as they exist today. Primary care is going to make in the lower 200 thousands as a W2 employee, 200,000 plus and high demand specialists might be able to start above 300,000. But these are starting, salaries and, the companies wanna make sure that you fit well with them, that you're going to stick around.
You do learn quite a bit in the first year or two that you're doing this kind of work. And, you know, there are other things built in along the way. Annual merit raises. There's quarterly or annual bonuses. There's sometimes stock grants and publicly traded companies that do this, many of which are publicly traded.
And if you consider. The hours and stress of being in practice, even if you make 10, 20, $30,000 less a year, it's still because you're only working, two thirds of the hours you would work in clinical practice. Quite often, it might be hard to reach a high enough salary to compete with a interventional cardiologist or orthopedic surgeon, something like that.
but those aside, I think I've never found a physician doing this job, that. Really didn't think it was a great amount of pay for what they were doing, and they were just so happy to be able to spend time with their family to go on vacations, to not have to drive to work. So you don't have that and it's really a positive environment.
Now you may have some something against doing reviews or using that as the way to control medical costs. And maybe at some point this will go away. But for now, it's the way it works. And. the physicians I've talked to are very happy doing this kind of job.
Now the other thing is the intellectual and professional appeal is, important 'cause you're using your education, training, and experience. For sure. Now, when you start, you're following criteria, actually, the nurses do most of the, initial reviewing, and they will approve or not approve something initially.
And then you might be the second level generally, and then you can get even deeper into specialty levels. but the issue is at, at that first level, you're just comparing the situation to the criteria that are written, published, and that all of you will learn when you work for a company like this. so a lot of this, if you're an internist and you're dealing with the run of the mill internal medicine adult.
Patient kind of issues, whether it's inpatient or outpatient, it's not going to be that complicated. you have the guidelines there to look at, to just make sure, usually, like I said, the nurse will maybe have denied it and then it comes to you and then you, you take a little more, nuanced or, or deeper level review and say, oh no, this definitely should be approved.
Or, oh, you can get this approved. Perhaps if you just document a little bit more your thinking and what is the indication for this test or why is this person on observation, rather than being an admission or vice versa, why they should be admitted rather than just stay observation, which is an outpatient situation.
So it's not really just a matter of chart review. You'll be kind of. Practicing medicine in the sense that you're using your education and training, at a different level. And, again, if you're a specialist, you even have a little bit of an edge, because they will need niche expertise in things like.
surgery and pediatrics and cardiology and so forth. And the other thing is that's nice about this position that makes it attractive is that there is a growth path. Physicians start out as novices, as beginners. They do it for a while if they like it, if they take to it, they keep doing it. And in the, in insurance industry side, they usually call you a medical director on the physician side.
Sometimes you're called a physician advisor. Many of those are also called medical directors for utilization management. You move up to a team leader, to a manager to higher leadership. In fact, the most of these organizations, the bigger ones, have a chief medical officer, which is an executive position, and that pays way more than what your entry level pay will be.
And it's a lot more fun, in my opinion. And again, there's always specialists who are highly valued in those high cost complex cases. So. There's another good aspect of this particular career. we think about the times maybe where we've had a run in with a reviewer or we think about, how if we're a little thin skin, how we're, we think people are second guessing our care, but it's usually just a documentation issue, maybe there's a gap in the documentation. 95% of peer-to-peer calls are respectful and collaborative. from everyone that I've spoken with, most of the calls are about gathering, missing information and, once that information is supplied the procedure, the admission, whatever is usually approved.
so. That's it. I mean, it's not meant to be, a negative experience, although in general we hate to spend the extra time doing this when we're in a busy practice trying to get patients taken care of. But the main thing is you wanna get the right care within the patient's benefit plan because of they don't do that ahead of time.
Then the patient's going to be stuck with some massive bill. And while they may blame the insurance company, they'll probably also blame their physician for ordering something or doing something that they didn't know would be covered. Nowadays everyone usually does pre-authorizations for almost any major procedure, not for an emergent admission of course, but the pre-auth have eliminated a lot of that.
risk of the patients being responsible for having to pay for something exorbitant. So that's that. Now. There is a proven entry way to get this kind of job. It may seem daunting at first, and there's certain parts of it that can be, but it is pretty straightforward. As I mentioned earlier, there's different way places you can work.
You can work at a, a. Large insurer, large payer, you can work for a hospital or health system. that's totally, those are totally two different jobs in a way. because most of the hospital based, you start as someone who is practicing there. Not necessarily they might hire you from outside the organization, but you could be practicing there.
Now you're going to go part-time as a physician advisor or medical director for, for, or case management and what have you. And you may eventually go full-time, but that's obviously a little different experience. And the way to approach that application process is a little different. So the third big one is to, to become employed by one of those big, payers.
Like whether it's Cigna or, CNC is another big one. Blue Cross Blue Shield, et cetera, et cetera. so let's start there. It's hard to get your first job full-time if you've not done any kind of work like this in the past. Now, if you're already doing part-time work in, this realm at the hospital where you work, that could be a shoe-in.
But the one that most people use is they continue to do clinical work and they apply for part-time. Remote positions in an IRO. An IRO is an independent review organization and it does reviews for certain types of situations. It also sometimes, is an add-on. And for temporary, coverage for, let's say a large insurer just doesn't have enough staff or, maybe they've added a new service line to cover that they didn't in the past or something like that.
So an IRO is hiring part-time people that work usually at their own. Time preference and they do reviews, just like you would do for an insurer, more or less. And you're going to be following, guidelines. You're going to usually have to be the second level of review after a nurse.
Screening has already rejected it, let's say. the easiest way to get into this type of role is to, work for one of those IROs part-time. And actually, it's not a bad idea to work for more than one. Try one. You might hate it. Try another IRO. They. They, they come in all shapes and sizes and they have different specialties that they focus on and that kind of thing.
And, the easiest way to get a list of the IROs is particularly the ones that have been around for a while, where, 'cause you can get burned in how you're paid with some of these startups where they come and they promise a lot and they pay you very little and maybe they don't even. Pay you completely and then they go outta business or something.
So you wanna go to the N-A-I-R-O, the National Association of IROs. The website for that is NAIR o.org, and I think it's right on the front page. The last time I checked, there was a list of all, well, all the members anyway, so not every IRO in the country is a member, but all the big ones are members and you can find out where they are, how to apply to them, look at their websites and so forth, and.
You can also find listings, like I said, you could just go to the IROs directly, but there are listings on Indeed, probably the biggest one that has those. I mean, there's literally dozens of jobs on Indeed for physicians in this realm. And you can go on LinkedIn and, there are headhunters that look for physicians on LinkedIn.
You can go to the, directly to the insurer's career page. And, this is where it gets a little tricky and a little frustrating maybe, but you're probably going to have to submit hundreds if not thousands of applications. Now I'm going to do a, a brief pause here to talk specifically about this process.
You're going to need, a resume. Okay? And you're going to have to send it in as, as they wish. They, sometimes they just take the resumes, resumes directly. Sometimes you can work through the person on, on LinkedIn that you line up with a headhunter or something. But ultimately you're going to have to send in your resume and not a cv.
They don't wanna see a 10 page cv. If you've done a lot of research, a lot of lectures, a lot of teaching, they don't care that much about it. Other, and kind of as a single entry on your resume. a resume is what most executives send in a CV is what clinical people and scientists send in. Okay? So you might have a cv, that's fine.
You don't wanna use your cv, you wanna convert that CV to a one or two page resume. And it needs to highlight any exposure you've had to this, situation. And I mean, you might. Even have your experiences as a provider interacting with, reviewers, but then, maybe you've had to be involved at your hospital with getting somebody admitted or an approval and you've done a, a hearing or something and, maybe you've.
done other things that relate to this and it you also wanna focus more on like, your, the way you think that whether you're a a people person, whether you tend to do well in groups and collaboration is important and patience is important and good. speaking and communication skills are important, so those can be reflected somehow in your resume.
I'm going to say a little bit more about that in a minute. but anyway, I just wanna do that little sort of sidebar. but you're going to go ahead and apply to any that look like they're interesting. If someone's looking, you just apply it looks interesting, sounds interesting. Don't go too deep into it.
If you actually get selected for an interview or something, then you can do that. But you wanna get the numbers out there and you wanna be applying every week, if not every day. And so expect to send out a lot. And I had some, one of my guests said that for the job she was looking for, she literally sent out over a thousand resumes before she got the job.
And that was not for a, job. That was a pharma job, but the idea is exactly the same and there's a reason. why. So let me give you the reason why this is important, because. Any single organization's needs will ebb and flow. So they may be fully staffed and not hiring for several months at a time, and then for some reason a market might open up.
they've got more activity, they've got more reviews, more denials, and so they need to hire. This is true actually in pharma. It's, it's why I thought of that person. 'cause she was experiencing the same thing. And, and as people applying to these, IROs and, the, utilization management companies, because when there's not a need, they just, the, the resumes stack up and they're electronic mostly.
And so then they just. Become unuseful. You're not going to go back to someone who applied three months ago because chances are you might have, that person may have already found another job. So the only ones really, and they use the euphemism as a way of a stack of, resumes on the desk, which is really not.
They, they're not physically on the desk anymore, but they're going to take the one on the top, the most recent one. They're going to look at it. If it meets their needs, they're going to call that person, they're going to give 'em the job. They're not going to go back 2, 3, 4 months. I don't even know if go, they'll go back then a couple of weeks, I guess, depends on how many they have, coming in on a regular basis.
So you have to keep jumping into that, active pool of people that are being reviewed, because again, if they're not. Hiring for two or three months, they're not going to go back and look at those. So that's, that's the reason that, you need to be, thick, thick skinned and not worry about whether, You didn't get someone call you back within 24 hours. and you might consider getting a coach to help you with this process. Someone who's probably a physician coach who works with careers, has worked with many, many people that have gone into utilization management. And you might join the, Facebook group called Remote Careers for Physicians.
If you gone. Facebook, you just put remote careers for physicians, you'll find it. It's got, I think, 16 to 20,000 members now, I'm not sure, and it has a lot of information and a lot of expertise where you can ask questions. So. Now what about contrast and contradictions? there's some differences between the hospital based and the insurance base.
Okay. The insurance is, for many people, the ideal. It's fully remote. You have great benefits, great pay. And it's a population focused, the hospital side's, same principles, but you might still be working as a clinician. Segueing over time you might be doing some clinical shifts. Still seems like the hospitals want you to keep seeing patients 'cause that part generates income, whereas the, kind of protects the income or at least lowers the costs.
And, it keeps you. Current, although again, for the most part, you're working off of, of, guidelines and requirements protocols. but if you're doing it well in a hospital, you can convert to insurance. And the thing is, once you're doing an insurance for a few years, if you don't have any clinical ongoing practice, then you're going to eventually lose your, ability to practice.
So you have to make sure that's what you want to do. In the hospital setting, you're already kind of ready to roll because you've been working under the system there. Most likely your hospital's going to employ you as a former or current practitioner. It's a little different to start from scratch, from in, insurance company 'cause they'll be completely foreign to you.
But it's still very straightforward in how to, get that done and, I think the pay is going to be better in the, in the insurer side. They're going to expect to pay you commensurate with your clinical, salary with consideration for the less hours that are worked. When you work in the hospital, they need you.
So they'll have you work what they need you to do, but they're going to sort of look at, particularly if you're already an employee of the hospital, they're going to look at your basic hourly rate and just convert it. So, okay, we're going to take every week you're going to take 20 hours and we're going to pay you roughly the same hourly rate you get as a physician.
That's kind of how that usually works. So you end up doing better under, for an insurer, plus the fact you don't have to drive to work and you can work at anywhere and it's all remote. All right. Next slide for those that are looking at the video. other contrasts well, is specialist friendly, so that's a good thing.
These things are what people agree on. They all agree that the community of, insurers and, and people doing that job is very supportive. And, in terms of getting your first job, they all, all my guests have agreed that applying a lot is the single biggest predictor of success. So if you can send in a thousand applications within three months, you'll probably have a job.
But if you can only send out five a week, that might take a while. Every once in a while you can get lucky though. And, most of the differences, in terms of satisfaction are about personal fit, not really the job quality. All right. Let's see. So what about actionable takeaways? So from what I've said so far, and before I let you go, do this today, go to Nero, look at those companies, see what they do, review, whatever materials on that NAIRO.org website and start applying to every IRO panel. There are a lot of those. Some of them are pretty small, but I think on that website when I looked, there might've been 30 when I looked. This was a while back.
Then weekly, you want to look at jobs online. So besides sending directly to those insurer sites for the IRO you can look for headhunters or job postings in LinkedIn. Which means you'll need to have a LinkedIn profile, which I'll talk about in a second. And Indeed is probably the one where there's the most activity for this, this kind of job. But any other online job site would be worth looking at. The big ones.
And if you're not already, join LinkedIn, this month sometime or the next month. join remote Careers for Physicians Facebook group. Start sending out cvs and consider getting coaching, or, For not only for a job search, but coaching simply for putting together your resume. Slide says cv, but no, it's definitely a resume rather than a CV.
And interview prep. It can be helpful. Your interviews are probably going to be remote 99% of the time, which is fine, but they're using, audio visual and So it's good to refresh what it's like to interview and it's a lot different than applying for a medical position, medical school position rather, or, residency or something like that.
but do those things. there you can listen to podcasts, look at some courses and so forth to learn about interview prep. but I would recommend, That if you consider, if you need help with putting together your resume and understanding what's expected or on using LinkedIn to find a job, you can get both of those for a minimal cost.
Really with Dr. Heather Fork at doctorscrossing.com. She's been around forever. She was, she's been a coach longer than I've been a podcaster. So you need to either read about what they're looking for on a resume or take a course like Heather Forks. That will help you a lot, otherwise concluding, I would say this, utilization management, one of the most accessible and rewarding nonclinical paths available to physicians.
In 2026. the jobs are waiting for you, which is a matter of timing. I would also say you should maybe reach out to some of your former co-residents and fellowship at, workers and see if they're doing some, and what they found out. And you can, go to and look up nonclinical careers on Facebook group.
There's four or five major groups where they'll, people will be happy to tell you what they're doing as a nonclinical physician, including this particular job. And, if you wanna get really aggressive at some point, and if you're thinking about fi hiring on with a certain company, you can talk to people that have worked there in the past by, again, going into these Facebook groups.
And there might be groups in other social media sites as well. so. The path is clear. the community is supportive and the rewards are really pretty substantial. You'll get your life back, you'll get time back with your family, and you won't have to worry about being sued by some unhappy patient. So with that, I am going to stop sharing and, basically I hope you found that to be useful.
That's it for today's presentation.
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The Amazing Truth About Utilization Management Jobs
You're listening to Physician Nonclinical Careers, episode number 449, the Amazing Truth About Physician Utilization Management Jobs.
Welcome back, nonclinical Nation. Today I am trying something new. And if it works, I'll replicate it. In future episodes, I'm going to take what I've learned about a particular career presented here over the past nine years and boil it down to a 20 minute or so presentation.
I hope to provide you an understanding of what the job entails, the pros and cons of choosing such a career, including the income that you generate and how to pursue it. One of the most popular options and one that has been addressed by at least six of my guests is the one I chose for today, and that's a career in Utilization Management.
Alright, today's topic, as I mentioned earlier, is the amazing truth about physician utilization management jobs.
Now let's look at the first slide here, and here's our agenda. basically this is how we're going to spend the next 20 minutes. we'll start with a quick overview. dive deep into some common themes that emerged from my own experience as a physician advisor for utilization management and my guests.
I will look honestly at a few differences and contradictions. Finish the exact steps you can take starting tomorrow. So, this will be a quick overview, but I think we'll hit the high points and, In just a very short time, explain why you should consider doing this job, why you shouldn't, what it's like and the steps to take to, to pursue this job.
So why does utilization management matter? Well, this is not a new thing. It's been around for years. In fact, I did this kind of job, I think almost 30 years ago, and everybody that I've interviewed, and if you just read about this, you'll find that, Basically, it's a process to make sure that patients get the right care in the right setting while controlling unnecessary cost and waste.
And it's, falls into different categories. There's prior authorizations. This can be outpatient or inpatient, concurrent reviews and retrospective reviews. And sometimes you're brought in for other things as well. And there's basically three main employer types. There's all the insurance companies I'm sure you're well aware of if you're dealing with them either in your office or at the hospital setting.
If you're in either of those settings. Hospital systems. That's where I started. I never did work for an insurance company, but my colleagues have. And, what's called an IRO, stands for Independent Review Organizations. So these are the ones that typically employ the part-time people to fill in for special things, for certain types of reviews, and,
The nice thing about the IROs is that they can serve as a training ground where you're still working your original clinical job, if that's what you're doing, and then segue into the more permanent full-time job. So, it's pretty straightforward how this works. There have been thousands and thousands of physicians that have done this, and we'll talk in a minute about why they've done it and how they've done it.
Okay. So the key themes here, we're going to talk about lifestyle. That's the thing. Lifestyle is really the major thing. Driving people to utilization management. So the ideal job, let's say you're working for an insurance company, is it's generally fully or mostly remote, but you can become fully remote for sure.
It's rare that you have to drive into an office to do these things 'cause they're all, all the reviews are done remotely. the, the. Time to work on this. Typically full-time, 35, 40 hours a week, no call, no medical records, and you have a salary. And if for some reason the week is slow because they don't have enough reviews for you to do, you get paid the same.
There's no on-call responsibilities. There's no nights, no weekends, no holidays. In general, you could probably find a rare situation where somebody needs an emergency review because of a hospitalized patient that may need to get a procedure or surgery or something. So you might have one person, in a large department available for those acute requests, but they're pretty rare and basically compared to medical practice the stress is much lower. It's a comfortable pace, and, you're not legally responsible in terms of any kind of liability for what happens. You don't have to have malpractice insurance if you're no longer seeing patients as a practicing physician, and, you don't actually interact with the patients.
I don't think ever.
So everybody that I've talked to, all my guests agreed this was the scenario, and that's why it's very attractive.
Now, how about the compensation? Here are the numbers as they exist today. Primary care is going to make in the lower 200 thousands as a W2 employee, 200,000 plus and high demand specialists might be able to start above 300,000. But these are starting, salaries and, the companies wanna make sure that you fit well with them, that you're going to stick around.
You do learn quite a bit in the first year or two that you're doing this kind of work. And, you know, there are other things built in along the way. Annual merit raises. There's quarterly or annual bonuses. There's sometimes stock grants and publicly traded companies that do this, many of which are publicly traded.
And if you consider. The hours and stress of being in practice, even if you make 10, 20, $30,000 less a year, it's still because you're only working, two thirds of the hours you would work in clinical practice. Quite often, it might be hard to reach a high enough salary to compete with a interventional cardiologist or orthopedic surgeon, something like that.
but those aside, I think I've never found a physician doing this job, that. Really didn't think it was a great amount of pay for what they were doing, and they were just so happy to be able to spend time with their family to go on vacations, to not have to drive to work. So you don't have that and it's really a positive environment.
Now you may have some something against doing reviews or using that as the way to control medical costs. And maybe at some point this will go away. But for now, it's the way it works. And. the physicians I've talked to are very happy doing this kind of job.
Now the other thing is the intellectual and professional appeal is, important 'cause you're using your education, training, and experience. For sure. Now, when you start, you're following criteria, actually, the nurses do most of the, initial reviewing, and they will approve or not approve something initially.
And then you might be the second level generally, and then you can get even deeper into specialty levels. but the issue is at, at that first level, you're just comparing the situation to the criteria that are written, published, and that all of you will learn when you work for a company like this. so a lot of this, if you're an internist and you're dealing with the run of the mill internal medicine adult.
Patient kind of issues, whether it's inpatient or outpatient, it's not going to be that complicated. you have the guidelines there to look at, to just make sure, usually, like I said, the nurse will maybe have denied it and then it comes to you and then you, you take a little more, nuanced or, or deeper level review and say, oh no, this definitely should be approved.
Or, oh, you can get this approved. Perhaps if you just document a little bit more your thinking and what is the indication for this test or why is this person on observation, rather than being an admission or vice versa, why they should be admitted rather than just stay observation, which is an outpatient situation.
So it's not really just a matter of chart review. You'll be kind of. Practicing medicine in the sense that you're using your education and training, at a different level. And, again, if you're a specialist, you even have a little bit of an edge, because they will need niche expertise in things like.
surgery and pediatrics and cardiology and so forth. And the other thing is that's nice about this position that makes it attractive is that there is a growth path. Physicians start out as novices, as beginners. They do it for a while if they like it, if they take to it, they keep doing it. And in the, in insurance industry side, they usually call you a medical director on the physician side.
Sometimes you're called a physician advisor. Many of those are also called medical directors for utilization management. You move up to a team leader, to a manager to higher leadership. In fact, the most of these organizations, the bigger ones, have a chief medical officer, which is an executive position, and that pays way more than what your entry level pay will be.
And it's a lot more fun, in my opinion. And again, there's always specialists who are highly valued in those high cost complex cases. So. There's another good aspect of this particular career. we think about the times maybe where we've had a run in with a reviewer or we think about, how if we're a little thin skin, how we're, we think people are second guessing our care, but it's usually just a documentation issue, maybe there's a gap in the documentation. 95% of peer-to-peer calls are respectful and collaborative. from everyone that I've spoken with, most of the calls are about gathering, missing information and, once that information is supplied the procedure, the admission, whatever is usually approved.
so. That's it. I mean, it's not meant to be, a negative experience, although in general we hate to spend the extra time doing this when we're in a busy practice trying to get patients taken care of. But the main thing is you wanna get the right care within the patient's benefit plan because of they don't do that ahead of time.
Then the patient's going to be stuck with some massive bill. And while they may blame the insurance company, they'll probably also blame their physician for ordering something or doing something that they didn't know would be covered. Nowadays everyone usually does pre-authorizations for almost any major procedure, not for an emergent admission of course, but the pre-auth have eliminated a lot of that.
risk of the patients being responsible for having to pay for something exorbitant. So that's that. Now. There is a proven entry way to get this kind of job. It may seem daunting at first, and there's certain parts of it that can be, but it is pretty straightforward. As I mentioned earlier, there's different way places you can work.
You can work at a, a. Large insurer, large payer, you can work for a hospital or health system. that's totally, those are totally two different jobs in a way. because most of the hospital based, you start as someone who is practicing there. Not necessarily they might hire you from outside the organization, but you could be practicing there.
Now you're going to go part-time as a physician advisor or medical director for, for, or case management and what have you. And you may eventually go full-time, but that's obviously a little different experience. And the way to approach that application process is a little different. So the third big one is to, to become employed by one of those big, payers.
Like whether it's Cigna or, CNC is another big one. Blue Cross Blue Shield, et cetera, et cetera. so let's start there. It's hard to get your first job full-time if you've not done any kind of work like this in the past. Now, if you're already doing part-time work in, this realm at the hospital where you work, that could be a shoe-in.
But the one that most people use is they continue to do clinical work and they apply for part-time. Remote positions in an IRO. An IRO is an independent review organization and it does reviews for certain types of situations. It also sometimes, is an add-on. And for temporary, coverage for, let's say a large insurer just doesn't have enough staff or, maybe they've added a new service line to cover that they didn't in the past or something like that.
So an IRO is hiring part-time people that work usually at their own. Time preference and they do reviews, just like you would do for an insurer, more or less. And you're going to be following, guidelines. You're going to usually have to be the second level of review after a nurse.
Screening has already rejected it, let's say. the easiest way to get into this type of role is to, work for one of those IROs part-time. And actually, it's not a bad idea to work for more than one. Try one. You might hate it. Try another IRO. They. They, they come in all shapes and sizes and they have different specialties that they focus on and that kind of thing.
And, the easiest way to get a list of the IROs is particularly the ones that have been around for a while, where, 'cause you can get burned in how you're paid with some of these startups where they come and they promise a lot and they pay you very little and maybe they don't even. Pay you completely and then they go outta business or something.
So you wanna go to the N-A-I-R-O, the National Association of IROs. The website for that is NAIR o.org, and I think it's right on the front page. The last time I checked, there was a list of all, well, all the members anyway, so not every IRO in the country is a member, but all the big ones are members and you can find out where they are, how to apply to them, look at their websites and so forth, and.
You can also find listings, like I said, you could just go to the IROs directly, but there are listings on Indeed, probably the biggest one that has those. I mean, there's literally dozens of jobs on Indeed for physicians in this realm. And you can go on LinkedIn and, there are headhunters that look for physicians on LinkedIn.
You can go to the, directly to the insurer's career page. And, this is where it gets a little tricky and a little frustrating maybe, but you're probably going to have to submit hundreds if not thousands of applications. Now I'm going to do a, a brief pause here to talk specifically about this process.
You're going to need, a resume. Okay? And you're going to have to send it in as, as they wish. They, sometimes they just take the resumes, resumes directly. Sometimes you can work through the person on, on LinkedIn that you line up with a headhunter or something. But ultimately you're going to have to send in your resume and not a cv.
They don't wanna see a 10 page cv. If you've done a lot of research, a lot of lectures, a lot of teaching, they don't care that much about it. Other, and kind of as a single entry on your resume. a resume is what most executives send in a CV is what clinical people and scientists send in. Okay? So you might have a cv, that's fine.
You don't wanna use your cv, you wanna convert that CV to a one or two page resume. And it needs to highlight any exposure you've had to this, situation. And I mean, you might. Even have your experiences as a provider interacting with, reviewers, but then, maybe you've had to be involved at your hospital with getting somebody admitted or an approval and you've done a, a hearing or something and, maybe you've.
done other things that relate to this and it you also wanna focus more on like, your, the way you think that whether you're a a people person, whether you tend to do well in groups and collaboration is important and patience is important and good. speaking and communication skills are important, so those can be reflected somehow in your resume.
I'm going to say a little bit more about that in a minute. but anyway, I just wanna do that little sort of sidebar. but you're going to go ahead and apply to any that look like they're interesting. If someone's looking, you just apply it looks interesting, sounds interesting. Don't go too deep into it.
If you actually get selected for an interview or something, then you can do that. But you wanna get the numbers out there and you wanna be applying every week, if not every day. And so expect to send out a lot. And I had some, one of my guests said that for the job she was looking for, she literally sent out over a thousand resumes before she got the job.
And that was not for a, job. That was a pharma job, but the idea is exactly the same and there's a reason. why. So let me give you the reason why this is important, because. Any single organization's needs will ebb and flow. So they may be fully staffed and not hiring for several months at a time, and then for some reason a market might open up.
they've got more activity, they've got more reviews, more denials, and so they need to hire. This is true actually in pharma. It's, it's why I thought of that person. 'cause she was experiencing the same thing. And, and as people applying to these, IROs and, the, utilization management companies, because when there's not a need, they just, the, the resumes stack up and they're electronic mostly.
And so then they just. Become unuseful. You're not going to go back to someone who applied three months ago because chances are you might have, that person may have already found another job. So the only ones really, and they use the euphemism as a way of a stack of, resumes on the desk, which is really not.
They, they're not physically on the desk anymore, but they're going to take the one on the top, the most recent one. They're going to look at it. If it meets their needs, they're going to call that person, they're going to give 'em the job. They're not going to go back 2, 3, 4 months. I don't even know if go, they'll go back then a couple of weeks, I guess, depends on how many they have, coming in on a regular basis.
So you have to keep jumping into that, active pool of people that are being reviewed, because again, if they're not. Hiring for two or three months, they're not going to go back and look at those. So that's, that's the reason that, you need to be, thick, thick skinned and not worry about whether, You didn't get someone call you back within 24 hours. and you might consider getting a coach to help you with this process. Someone who's probably a physician coach who works with careers, has worked with many, many people that have gone into utilization management. And you might join the, Facebook group called Remote Careers for Physicians.
If you gone. Facebook, you just put remote careers for physicians, you'll find it. It's got, I think, 16 to 20,000 members now, I'm not sure, and it has a lot of information and a lot of expertise where you can ask questions. So. Now what about contrast and contradictions? there's some differences between the hospital based and the insurance base.
Okay. The insurance is, for many people, the ideal. It's fully remote. You have great benefits, great pay. And it's a population focused, the hospital side's, same principles, but you might still be working as a clinician. Segueing over time you might be doing some clinical shifts. Still seems like the hospitals want you to keep seeing patients 'cause that part generates income, whereas the, kind of protects the income or at least lowers the costs.
And, it keeps you. Current, although again, for the most part, you're working off of, of, guidelines and requirements protocols. but if you're doing it well in a hospital, you can convert to insurance. And the thing is, once you're doing an insurance for a few years, if you don't have any clinical ongoing practice, then you're going to eventually lose your, ability to practice.
So you have to make sure that's what you want to do. In the hospital setting, you're already kind of ready to roll because you've been working under the system there. Most likely your hospital's going to employ you as a former or current practitioner. It's a little different to start from scratch, from in, insurance company 'cause they'll be completely foreign to you.
But it's still very straightforward in how to, get that done and, I think the pay is going to be better in the, in the insurer side. They're going to expect to pay you commensurate with your clinical, salary with consideration for the less hours that are worked. When you work in the hospital, they need you.
So they'll have you work what they need you to do, but they're going to sort of look at, particularly if you're already an employee of the hospital, they're going to look at your basic hourly rate and just convert it. So, okay, we're going to take every week you're going to take 20 hours and we're going to pay you roughly the same hourly rate you get as a physician.
That's kind of how that usually works. So you end up doing better under, for an insurer, plus the fact you don't have to drive to work and you can work at anywhere and it's all remote. All right. Next slide for those that are looking at the video. other contrasts well, is specialist friendly, so that's a good thing.
These things are what people agree on. They all agree that the community of, insurers and, and people doing that job is very supportive. And, in terms of getting your first job, they all, all my guests have agreed that applying a lot is the single biggest predictor of success. So if you can send in a thousand applications within three months, you'll probably have a job.
But if you can only send out five a week, that might take a while. Every once in a while you can get lucky though. And, most of the differences, in terms of satisfaction are about personal fit, not really the job quality. All right. Let's see. So what about actionable takeaways? So from what I've said so far, and before I let you go, do this today, go to Nero, look at those companies, see what they do, review, whatever materials on that NAIRO.org website and start applying to every IRO panel. There are a lot of those. Some of them are pretty small, but I think on that website when I looked, there might've been 30 when I looked. This was a while back.
Then weekly, you want to look at jobs online. So besides sending directly to those insurer sites for the IRO you can look for headhunters or job postings in LinkedIn. Which means you'll need to have a LinkedIn profile, which I'll talk about in a second. And Indeed is probably the one where there's the most activity for this, this kind of job. But any other online job site would be worth looking at. The big ones.
And if you're not already, join LinkedIn, this month sometime or the next month. join remote Careers for Physicians Facebook group. Start sending out cvs and consider getting coaching, or, For not only for a job search, but coaching simply for putting together your resume. Slide says cv, but no, it's definitely a resume rather than a CV.
And interview prep. It can be helpful. Your interviews are probably going to be remote 99% of the time, which is fine, but they're using, audio visual and So it's good to refresh what it's like to interview and it's a lot different than applying for a medical position, medical school position rather, or, residency or something like that.
but do those things. there you can listen to podcasts, look at some courses and so forth to learn about interview prep. but I would recommend, That if you consider, if you need help with putting together your resume and understanding what's expected or on using LinkedIn to find a job, you can get both of those for a minimal cost.
Really with Dr. Heather Fork at doctorscrossing.com. She's been around forever. She was, she's been a coach longer than I've been a podcaster. So you need to either read about what they're looking for on a resume or take a course like Heather Forks. That will help you a lot, otherwise concluding, I would say this, utilization management, one of the most accessible and rewarding nonclinical paths available to physicians.
In 2026. the jobs are waiting for you, which is a matter of timing. I would also say you should maybe reach out to some of your former co-residents and fellowship at, workers and see if they're doing some, and what they found out. And you can, go to and look up nonclinical careers on Facebook group.
There's four or five major groups where they'll, people will be happy to tell you what they're doing as a nonclinical physician, including this particular job. And, if you wanna get really aggressive at some point, and if you're thinking about fi hiring on with a certain company, you can talk to people that have worked there in the past by, again, going into these Facebook groups.
And there might be groups in other social media sites as well. so. The path is clear. the community is supportive and the rewards are really pretty substantial. You'll get your life back, you'll get time back with your family, and you won't have to worry about being sued by some unhappy patient. So with that, I am going to stop sharing and, basically I hope you found that to be useful.
That's it for today's presentation.
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