What the work involves
A utilization review physician helps a hospital or review organization decide on medical necessity for admissions, duration of stay and services. The setting and the criteria vary by employer.
Who the work may fit
This can fit physicians with inpatient or case-review experience. Ask which criteria you would apply and how disagreements are escalated.
Questions before you say yes
- Which organization am I reviewing for?
- Which criteria or policies apply?
- Whose cases will I review and will I have any link to them?
- How are disagreements and appeals handled?
- How is the role paid and what volume is expected?
Your first step
Ask for the review policy, a sample case and the escalation route. Confirm in writing that you will not review cases where you were involved or have an ownership interest.
What can go wrong
Reviewing cases where you have a conflict, or accepting volume targets that pressure your judgment.
How to get started, step by step
Turn the idea into a specific next action. These are preparation steps, not approval to perform a role.
- Ask what type of review the role covers: admissions, length of stay or services.
- Request the criteria and policies you would apply.
- Confirm your conflict-of-interest obligations in writing.
- Ask how appeals and disagreements are handled.
- Agree on pay, volume and schedule before starting.
Where to look and who to ask
Use search terms and contacts that fit this work. Check the actual source and current requirements; these suggestions are not verified openings or Saile inventory.
- Ask hospital quality or case-management departments about physician advisor roles.
- Ask review organizations about their physician reviewer programs.
- Check the Medicare hospital condition of participation on utilization review.
Scheduling and payment realities
Reviews often run on turnaround deadlines. Ask what response times are expected.
Keep gross pay and taxes separate
For federal employment taxes, the IRS considers control and the relationship, not only the contract label. Self-employed individuals generally pay income and self-employment tax and may need estimated payments. Keep payment and expense records and ask a tax professional about your actual arrangement; this guide does not calculate take-home pay.
IRS: Independent contractor or employee
IRS: Self-employed individuals tax center
Before you say yes: a final checklist
Do not let an unanswered question become an assumed term.
- Do I know the criteria?
- Have I checked conflicts?
- Is the escalation route written down?
- Is volume realistic?
- Are pay terms in writing?
Work types to compare
Telemedicine
Compare visit type, patient states, schedule and clinical support.
Locum tenens
Compare assignment duties, onboarding, travel and written terms.
Per diem / PRN
Compare minimum commitments, offered shifts and cancellation rules.
Consulting / project work
Compare eligibility, deliverables, conflicts and review deadlines.
Frequently asked questions
How much does this work pay?
This guide does not quote a market rate or promise earnings. Compare a verified written offer, including all required work and expenses.
Does Saile have this work available now?
Check the Saile app for current openings. This educational guide does not claim that a particular role or project is available.
Can I do this alongside my main job?
Check outside-work approval, conflicts, confidentiality and scheduling obligations before accepting.
What should I get in writing?
The work, deliverables, schedule, payment terms, coverage responsibilities, cancellation terms and the steps required before starting.
What should I do next?
Request a sample task without unnecessary patient information, a review policy and an escalation path. Read confidentiality and liability terms before taking access to records.
What the primary sources say
The Medicare hospital condition of participation on utilization review says a hospital must have a utilization review plan that covers review of services furnished by the institution and by members of its medical staff to Medicare and Medicaid patients. The committee must have two or more practitioners, and at least two members must be doctors of medicine or osteopathy. Reviews may not be conducted by anyone who has a direct financial interest in the hospital, such as an ownership interest, or who was professionally involved in the care of the patient being reviewed. The plan must provide for review of the medical necessity of admissions, the duration of stays and professional services furnished. Use these rules as a checklist when you ask about a review role.