Physician Reviewer Jobs for OPT Students
Physician Reviewer roles sit at the intersection of clinical expertise and administrative decision-making, making them a strong OPT fit for medical graduates with U.S. training. Most positions require an active medical license, so confirm your state licensure timeline aligns with your OPT authorization window before applying.
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Get Access To All JobsWe’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Job Profile Summary
The Utilization Management Physician Reviewer ensures timely and clinically sound coverage determinations for inpatient and outpatient services using evidence-based criteria, clinical judgment, and organizational policies. This role collaborates with internal and external care teams to recommend appropriate care and maintain compliance with CMS and payer guidelines. Responsibilities include reviewing service requests, documenting decisions, participating in quality improvement initiatives, and supporting care coordination efforts. Candidates must be licensed MDs or DOs with 3–5 years of clinical experience, including at least one year in utilization management for Medicare or Medicaid populations. Strong communication, managed care expertise, and attention to detail are essential for success.
Role Description
The Utilization Management Physician Reviewer-FT role is responsible for provisioning accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management (UM) criteria, clinical judgment, and internal policies and procedures. Regardless of the final determination, the Physician Reviewer is responsible for ensuring medically appropriate care is recommended to the patient and their care team, which may require coordination with internal and external parties including, but not limited to requesting providers, external UM and case management staff, internal transitional care managers, employed primary care providers, and regional medical leaders. We strive for clinical excellence and ensuring our patients receive the right care, in the right setting, at the right time.
Core Responsibilities:
(Weekend Coverage is Required)
- Review service requests and document the rationale for the decision in easy to understand language per organizational policies and procedures and industry standards; types of requests include but not limited to: Acute, Post-Acute, and Pre-service (Expedited, Standard, and Retrospective)
- Use evidence-based criteria and clinical reasoning to make UM determinations in concert with an enrollee’s individual conditions and situation. The organization does not solely make authorization determinations based on criteria, but uses it as a tool to assist in decision making.
- Work collaboratively with the Transitional Care and PCP care teams to drive efficient and effective care delivery to patients
- Maintain knowledge of current CMS and MCG evidence-based guidelines to enable UM decisions
- Maintain compliance with legal, regulatory and accreditation requirements and payor partner policies
- Participate in initiatives to achieve and improve UM imperatives; for example, participate in committees or work-groups to help advance UM efforts and promote a culture of continuous quality improvement
- Assist in formal responses to health plan regarding UM process or specific determinations on an as-needed basis
- Adhere to regulatory and accreditation requirements of payor partners (e.g., site visits from regulatory & accreditation agencies, responses to inquiries from regulatory and accreditation agencies and payor partners, etc.)
- Participate in rounding and patient panel management discussions as required
- Fulfill on-call requirement, should the need arise
- Other duties, as required and assigned
What are we looking for?
- A current, clinical, in good standing, unrestricted license to practice medicine (NCQA Standard)
- Graduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA Standard)
- Experience: 3-5 years of clinical practice in a primary care setting with at least one year experience providing Utilization Management services to a Medicare and/or Medicaid line of business
- Excellent verbal and written communication skills
- Deep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management
- Strong record of continuing education activities (relevant to practice area and needed to maintain licensure)
- Demonstrated understanding of culturally responsive care
- Proven organizational and detail-orientation skills
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$174,070.00 - $374,920.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 07/31/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Job Profile Summary
The Utilization Management Physician Reviewer ensures timely and clinically sound coverage determinations for inpatient and outpatient services using evidence-based criteria, clinical judgment, and organizational policies. This role collaborates with internal and external care teams to recommend appropriate care and maintain compliance with CMS and payer guidelines. Responsibilities include reviewing service requests, documenting decisions, participating in quality improvement initiatives, and supporting care coordination efforts. Candidates must be licensed MDs or DOs with 3–5 years of clinical experience, including at least one year in utilization management for Medicare or Medicaid populations. Strong communication, managed care expertise, and attention to detail are essential for success.
Role Description
The Utilization Management Physician Reviewer-FT role is responsible for provisioning accurate and timely coverage determinations for inpatient and outpatient services by applying utilization management (UM) criteria, clinical judgment, and internal policies and procedures. Regardless of the final determination, the Physician Reviewer is responsible for ensuring medically appropriate care is recommended to the patient and their care team, which may require coordination with internal and external parties including, but not limited to requesting providers, external UM and case management staff, internal transitional care managers, employed primary care providers, and regional medical leaders. We strive for clinical excellence and ensuring our patients receive the right care, in the right setting, at the right time.
Core Responsibilities:
(Weekend Coverage is Required)
- Review service requests and document the rationale for the decision in easy to understand language per organizational policies and procedures and industry standards; types of requests include but not limited to: Acute, Post-Acute, and Pre-service (Expedited, Standard, and Retrospective)
- Use evidence-based criteria and clinical reasoning to make UM determinations in concert with an enrollee’s individual conditions and situation. The organization does not solely make authorization determinations based on criteria, but uses it as a tool to assist in decision making.
- Work collaboratively with the Transitional Care and PCP care teams to drive efficient and effective care delivery to patients
- Maintain knowledge of current CMS and MCG evidence-based guidelines to enable UM decisions
- Maintain compliance with legal, regulatory and accreditation requirements and payor partner policies
- Participate in initiatives to achieve and improve UM imperatives; for example, participate in committees or work-groups to help advance UM efforts and promote a culture of continuous quality improvement
- Assist in formal responses to health plan regarding UM process or specific determinations on an as-needed basis
- Adhere to regulatory and accreditation requirements of payor partners (e.g., site visits from regulatory & accreditation agencies, responses to inquiries from regulatory and accreditation agencies and payor partners, etc.)
- Participate in rounding and patient panel management discussions as required
- Fulfill on-call requirement, should the need arise
- Other duties, as required and assigned
What are we looking for?
- A current, clinical, in good standing, unrestricted license to practice medicine (NCQA Standard)
- Graduate of an accredited medical school. M.D. or D.O. Degree is required. (NCQA Standard)
- Experience: 3-5 years of clinical practice in a primary care setting with at least one year experience providing Utilization Management services to a Medicare and/or Medicaid line of business
- Excellent verbal and written communication skills
- Deep understanding of managed care, risk arrangements, capitation, peer review, performance profiling, outcome management, care coordination, and pharmacy management
- Strong record of continuing education activities (relevant to practice area and needed to maintain licensure)
- Demonstrated understanding of culturally responsive care
- Proven organizational and detail-orientation skills
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$174,070.00 - $374,920.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 07/31/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
How to Get Visa Sponsorship in Physician Reviewer
Confirm your medical license is OPT-compatible
State medical licenses can take three to six months to process. Apply for licensure as early as possible so your license is active before your OPT start date, since most Physician Reviewer roles require it on day one.
Target employers who regularly hire foreign-trained physicians
Health insurance companies, utilization management firms, and telehealth platforms hire Physician Reviewers at scale and often have established processes for sponsoring H-1B visas after OPT, making them more predictable partners for international candidates.
Emphasize clinical decision-making in your application materials
Physician Reviewer roles prioritize evidence-based judgment over bedside manner. Highlight experience reviewing cases, applying clinical criteria, or working with utilization management guidelines to show you can contribute immediately without an adjustment period.
Understand STEM OPT extension eligibility for this role
Physician Reviewer positions at health technology or data-driven companies may qualify for the 24-month STEM OPT extension if your degree is in a STEM-designated field. Confirm with your DSO whether your specific employer and degree combination qualifies.
Ask directly about H-1B sponsorship during the offer stage
Physician Reviewer roles frequently qualify as specialty occupations under H-1B rules given the MD or DO requirement. Raise sponsorship during offer negotiations, not after accepting, to ensure the employer is committed before you start the clock on OPT.
Document your clinical training hours carefully
Some employers verify that foreign medical graduates meet minimum supervised clinical training hours equivalent to U.S. residency standards. Keep records of your training, rotations, and any ECFMG certification to streamline the background verification process.
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Get Access To All JobsFrequently Asked Questions
Can I work as a Physician Reviewer on OPT without completing a U.S. residency?
Many Physician Reviewer positions accept international medical graduates with an active U.S. medical license without requiring completed residency, though requirements vary by employer. Roles focused on utilization review, prior authorization, or case management tend to have more flexible clinical experience requirements than those tied to direct patient care or academic institutions. Review each job description carefully for specific credentialing criteria.
Does a Physician Reviewer role qualify for the STEM OPT extension?
It depends on your degree and employer. If your qualifying degree is in a STEM-designated field and the employer uses E-Verify, you may be eligible for the 24-month STEM OPT extension. A standard MD or DO from a non-STEM program typically does not qualify on its own, but a degree in biomedical engineering, health informatics, or a related STEM field could. Confirm eligibility with your DSO before assuming you qualify.
How do I find Physician Reviewer jobs that are open to OPT candidates?
Migrate Mate is the recommended starting point. It surfaces Physician Reviewer listings specifically filtered for employers willing to work with OPT and visa sponsorship candidates, saving you the time of screening through postings that exclude international applicants. Focus your search on health plans, managed care organizations, and utilization management companies, which hire Physician Reviewers in volume and tend to have HR infrastructure for international hires.
Will my OPT authorization cover part-time Physician Reviewer work?
Yes. OPT allows both full-time and part-time employment as long as the work is directly related to your field of study. Part-time Physician Reviewer roles, including contract or per-diem positions, count toward your OPT work requirement provided they meet the 20-hours-per-week minimum while school is in session, or exceed 20 hours during official school breaks. Track your hours carefully and report any employer changes to your DSO promptly.
What happens if my OPT expires before my H-1B is approved?
If your employer files an H-1B petition on your behalf before your OPT expires and you have a timely filed receipt, you may be eligible for a cap-gap extension that bridges your authorized stay through September 30 of the fiscal year. For Physician Reviewer roles, which typically qualify as H-1B specialty occupations, this protection is meaningful. Work closely with your employer's immigration counsel and your DSO to track your OPT expiration date relative to the H-1B filing window.
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