Earn Extra Income and Learn a New Skill Doing Utilization Review!


Would you like to use your medical knowledge, earn extra income, and learn a new skill?

Independent utilization review (sometimes called “chart review”) is a great way to do all of the above, as well as explore a potential nonclinical job while you’re still in practice. 

Today we’re diving in with radiologist Dr. Michelle Sterling, who is the Executive Medical Director – Clinical Quality at Medical Review Institute of America, LLC, (MRIoA).  One aspect of her job is overseeing physicians who do external utilization reviews on behalf of MRIoA.

Dr. Sterling shares a lot of helpful information about doing utilization reviews and also mentions which specialties MRIoA is currently recruiting for. 

How did you get started in utilization management?

I was very unhappy in my career as a radiologist and I knew I needed a change. It was important for me to use my medical degree that I had worked so hard to obtain. Also, I was frustrated with the overutilization of certain resources that I was seeing as a radiologist.

I worked with Heather to help figure out what the best path was for my future. She told me about an opening at MRIoA and I applied. That was 3 ½ years ago and I love what I do. I started out doing utilization management but have transitioned into an executive management level position and now I oversee our external physician reviewers alongside our Director of Provider Relations.

I really enjoy working with the reviewers on our specialty panel and I have learned a lot from them. We have some internal reviewers who work full time, but most of our reviewers are specialists in clinical practice who perform the external reviews as independent contractors a few hours per week.

What kind of work are the external physician reviewers doing?

In most cases they are reviewing medical and/or pharmacy claims – initial prior authorizations and appeals. These reviews fall into several different categories:

Criteria Based Reviews – making sure specific criteria for the medical plan is being met, Medical Necessity – making sure the service or drug is appropriate for the patient’s condition or Investigational and Experimental Treatments.

What is a typical day like for an external reviewer?

Our external reviewers are in active practice and spending their day as most physicians do in their busy practices. The only difference is when a patient cancels or they have a little downtime in their day, these physicians can work on reviews they have already been assigned by MRIoA.  

Some reviewers like to schedule our reviews while they eat lunch, or before or after seeing patients. It is really a flexible process so that it can meet their own scheduling needs. Typically, cases have a 24 or 48-hour turnaround time, (TAT). The reviews themselves vary with some being 5 – 10 minutes, while others may take from 30 – 60 minutes or longer to complete. The reviewers work with MRIoA to find the types of reviews that fit their personality and skill set.

What do the physician reviewers most enjoy about doing this work?

The physicians enjoy knowing they’re helping patients get the appropriate care they need. Sometimes an incorrect study is ordered and the reviewer can make recommendations regarding alternatives to assist in getting the patient the proper study or treatment. They also feel the work helps them stay on top of industry standards and current literature. After residency, practice is so busy that it can be hard to keep up with the literature and advancements, and doing the reviews is a great way to stay current.

Are there any downsides to doing review work?

Sometimes you might not have enough information to make a determination; however, there are additional levels of appeals.

The peer-to-peer calls can also sometimes be stressful; however, to be honest, the vast majority of peer-to-peer calls that I have completed are positive. Depending on what the case is, you might be able to obtain additional information which could lead to the request being approved. Or there might be an alternative approach that can be taken.

Is the time frame required to complete a case a challenge for some of the reviewers?

In order to do this type of work you need to have the commitment to meet the deadlines because the TATs (turn-around-times) are regulated. The good news is you can turn your availability off at any time for things like a call day, if you’re in the OR, or during a week where you’re especially busy. When you mark yourself unavailable in our system, you won’t be contacted for reviews.

What is the compensation like?

Physician reviewers are paid on a case by case basis. Payment on each case is determined according to the complexity of the case – the more complex (and longer the case) the higher the reimbursement. Rates also vary depending on specialty.

How would a physician know if Review Work is right for them?

If you are concerned about the over-utilization of services and want patients to get appropriate but not unnecessary treatment, this could be a reason for wanting to do review work.

The extra income is a nice perk too. Trying out utilization review is also a good way to see if you might want to transition later into doing something full time in this area. It also can be a good addition to your resume.

What do you tell physicians who are reluctant to do this work because of the peer-to-peer calls?

It is rewarding when you can talk to a fellow physician and get new information about a patient that could lead to a favorable determination. While their request may not meet criteria for what they wanted, you might be able to suggest an alternative and the doctor is happy.

The reviewers become more comfortable in time with the peer-to-peers and the ability to handle challenging conversations is a good skill to have. If a physician doesn’t like any kind of conflict, then this type of work may not be a good fit.

What advice would you give someone interested in doing Review work?

If you feel you would find this type of work rewarding, try it!  We don’t have minimum case volume expectations or require the external reviewers to commit to working with us for any length of time.  As you are starting out, our team checks in with you frequently to see how you are doing, what you like, and talks with you about what you’re struggling with. This also helps us figure out what types of cases work best for you, which ultimately works better for us. Hopefully, you’ll enjoy the work and will want to continue. 

What question do you get asked by reviewers most often?

Almost every new reviewer asks if they have to deny a certain number of reviews in order to work with MRIoA. And the answer is NO! We do not keep track of approvals versus denials for any one reviewer. The goal is and always will be to make the right determination for the patient and prescribing physician whether it is an approval or denial.

What are MRIoA’s requirements for physicians who want to do utilization review?

The physicians need to be board-certified, have an active, unrestricted license, be currently practicing a minimum of 8 hours a week, and have at least 5 years of clinical experience which can include residency. 

Is specific training needed?

There is no training needed prior to beginning review work. If you are interested, you would first complete a test case. Once the test case is reviewed, there is a 45-minute training session where we go over expectations and instructions on different case types and case requirements.  We also have a clinical team available for questions on cases as you are completing them.

Are you currently recruiting any physicians as independent contractors to be external reviewers?

We have physicians on our panels specializing in about 150 different specialty areas.  Many of those specialty areas are currently full, but there are still a lot of areas where we are looking for new reviewers to help with our increasing volume of cases.

We are actively recruiting for:

Orthopedic Surgeons, Psychiatrists, Anesthesiologists with Pain Medicine Certification, and PM&R with Pain Medicine Certification.  We are also recruiting for Internal Medicine/Occupational Medicine dual board certification specialists, Vascular Surgeons, Neuro-Ophthalmologists, and Oncologists.

Adding to our waitlist:

For now, we don’t have needs in other areas like Family Medicine, Internal Medicine, Emergency Medicine, or Pediatrics. However, we do keep waiting lists of those who are interested and can let them know when we do have needs that arise.  

Who should physicians contact for more information?

They can email Medical.Opportunities@mrioa.com  or call (801) 265-6427.

A big Thank You to Dr. Michelle Sterling for coming on the blog and providing all this useful information!

Latest Posts

Find what you're looking for:

Posted in

Heather Fork

Leave a Comment

Tim O

The coaching I have had with you has been life changing."

You helped me find the courage to seek out leadership positions and become a medical director as well as a physician advisor. I am grateful we crossed paths and am a different person because of it. You have inspired me to "believe" in spite of my inner skeptic. I consider you one of my most important mentors and am proud to also call you a friend. This says a lot given the apprehension I felt when I took a chance with our first coaching session. Even though I have already made a successful transition, I still value your ongoing mentorship and can enthusiastically attest that the value of your services is tremendous!

- Tim Owolabi, MD

Family Medicine
Lynette Charity

“I was at a crossroads in my medical career. I asked myself, "Do I stay or do I go?" 

I met Heather at the SEAK conference. She and I revisited this question.  Did I want to quit being medicine completely? She helped me to identify my needs, wants, and my vision for my FUTURE, not just in medicine, but in life!!!

She was able to listen to my "ramblings" about becoming a stand-up comic, lounge singer and voice-over actor and translate them into action steps.  I chose to become a composite of all of these. Now I am a more confident, healthier, happier person. I credit this in its entirety to the tutelage I have received and continue to receive from Heather.  She cares. She listens. She was there for ME.  She will be there for YOU!

- Lynette Charity, MD

Gail Miller

“I am forever grateful to Heather for helping me to recognize, I am more than just my M.D." 

Heather helped me understand that I am more than just a doctor and that my experiences in clinical medicine are valuable in so many arenas.  As a result I realized that there are other ways to use my background, still be able to help people and continue to challenge myself and grow.  To that end I discovered coaching - specifically health coaching.  I am on my journey becoming a health coach and truly loving it!

- Gail Miller, MD

OB/Gyn physician

“Thank you, Heather, for helping me transform my career, my faith and my life."

What started out as an initial thirty-minute consultation call turned into an amazing four-year journey that transformed my life, personally, spiritually and professionally. 

Heather helped me to discover my passions...by doing so, I discovered I still had a calling for medicine but it now came from a place of truth...

Today...my wife and I are opening our first concierge medicine clinic in a community we love. I’m actually excited to have the opportunity to practice medicine the way I believe it’s meant to be, with a focus on the doctor-patient relationship and an emphasis on faith. I know if I had not reached out to Dr. Fork, my life would not be where it is at today.

- Steve Lapke, MD

Papillion, NE
Sue Zimmermann

“Heather gave me the confidence to create a new livelihood by following my heart."

She is incredibly knowledgeable about the range of careers available to physicians and provided me with advice and connections which I would not have found on my own.  From the start she encouraged me to step out of my comfort zone and try different things.  I was laid off unexpectedly in early 2017, and Heather gave me the confidence to create a new livelihood by following my heart and making decisions based on trust, not fear.  Now I am enjoying working part-time in a clinical setting in addition to teaching and writing.

- Sue Zimmermann, MD

Orthopedic Surgeon
Devki Patel

After months of struggling to find a non-clinical career that matched my values and passion, I stumbled upon Heather's website which truly changed my life."

Heather's insightful and personalized approach to career coaching made me think outside the box since she took the time to evaluate my personality, values, interests, and preferred lifestyle.

Through her encouragement, practical advice, and professional connections, I was able to find a non-clinical position at a state Medicaid agency that aligned with my passion for population health and serving low-income communities. In addition to her coaching sessions, Heather has built a community of like-minded physicians through her blog, and I feel honored to recommend her to friends and colleagues who seek to make positive changes in their professional and personal lives.

- Devki Patel, MD

Jay Macregor

Working with Heather ultimately helped me leave my job in corporate healthcare and find a path that was much more fulfilling."

My career was going reasonably well but I couldn’t shake this nagging feeling I could do better; or at least find a better long-term career fit.  

I was able to find a surgery job that better aligned with my goals and professional interests.  Additionally, Heather helped me start a consulting business which has allowed me to pursue a true passion: helping medical students, residents, and attendings surgeons navigate the challenges of high-stakes standardized exams.    

If you are reading this as a “Type A” surgeon who doesn’t think coaching is for you, I would encourage you to give Heather a shot.  I’m very glad I did!

- Jay MacGregor, MD

Colorectal Surgeon

“I gained the confidence in myself to develop an action plan that blended the best parts of my experiences and interests into a cohesive career." 

Through our work, I learned to trust myself to make good decisions for my own future – something I hadn’t realized I was struggling with because as an emergency physician, I make life-changing decisions with patients every day. 

By feeding my creativity and interests in other realms of my professional life, I’ve found renewed compassion for my patients and myself, making every shift an opportunity to actually care for people. Thank you Heather. I really couldn’t have made these changes without your help!

- Liz McMurtry, DO

Emergency Medicine Physician

The simple truth is - Heather Fork totally helped me change my life."

I never would have had the courage to make the changes I’ve made without her unwavering support, wealth of knowledge and commitment. 

When I first started working with Heather, I was downtrodden...I’d been practicing medicine for 20+ years and yet had never quite found my place.  During the first year I worked with Heather, I left the practice I’d been working at, and recreated an entirely new professional purpose.

I’m now an executive and leadership coach, a university professor, and a Brené Brown Daring Way facilitator, and I have never looked back.  I love what I am doing more than at any other time in my professional life and I credit Heather with seeing in me what I was never able to see in myself, until now.

Don’t hesitate, don’t doubt yourself, schedule your time with Heather as soon as possible- she can help you reconnect to your purpose and reinvent your life.

- Amie Langbein, DO

Family Physician
Untitled design

"After 30 years in academic medicine, I wanted a career change but had no idea where to start. Medicine was all I knew."

I signed up for coaching with Heather and it transformed my life. She helped me get clear on what I wanted my life to look like. We reviewed my skills, values, and strengths. She instilled hope in me that change IS possible after 50 years! 

The outcome is that I have created a life I love! I practice endocrinology part-time and own a life coaching business! Coaching with Heather is one of the best investments I have made in my life. 

- Karen Barnard, MBBCh, MPH

Endocrinologist and Life Coach

"Heather’s approach was great! She would listen to me and helped me appreciate who I am."

I remember when she said ‘do your resume before our next meeting’, I was about to push back but she gently nudged me along and I’m glad I did exactly what she wanted me to do. We also did interview prep via Zoom and I was offered a great job in UM. She has continued to follow up even after I was offered this job, helping me with pointers about negotiating. I will totally recommend the Doctors Crossing and Heather to anyone feeling stuck like me and looking for a great coach! Thank you Heather!

- Modupe Oladeinde, MD

Family Medicine