Physician Advisor, Part-Time

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct clinical evaluations in alignment with Managed Care and CMS Regulatory Requirements.

• Support level of care and length of stay management on an individual case basis.

• Aid in the denial management process.

• Assess whether established standards of quality care are satisfied.

• Engage in concurrent and retrospective appeal peer-review processes.

• Provide insights to internal and external stakeholders on level of care, length of stay, quality concerns, physician conduct, and documentation.

• Suggest and request additional medical record documentation as necessary.

• Advise staff on status issues and alternatives to acute care.

• Train staff on regulatory mandates, suitable utilization, and alternative care levels.

• Record patient care reviews, decisions, and relevant information.

• Evaluate cases using screening criteria such as InterQual and MCG.

• Develop and implement evidence-based medicine and utilization protocols.

• Collaborate with Care Management staff to ensure continuity of care and minimize readmission rates.

• Instruct staff on ICD coding guidelines, clinical terminology, severity, acuity, mortality risk, and DRG assignments.

• Offer insights into XSOLIS appeal operations and the development of technology platforms.

• Partner with the Data Analytics team to improve clinical analytics.

• Stay updated on federal, state, payer regulatory, and contractual requirements.

• Perform peer-to-peer reviews if employed full-time.

• Operate as an independent contributor without direct reports.

⛳️ Requirements

• Graduate from an accredited medical school.

• Additional training in quality and utilization management through continuing medical education and self-directed study.

• A minimum of 5 years of recent clinical practice experience.

• Licensed physician without any restrictions.

• Familiarity with federal, state, payer regulatory, and contractual requirements.

• Experience in utilization management or as a physician advisor is preferred.

• Strong verbal and written communication skills.

• Basic computer proficiency, including typing and browser navigation.

• Competence with MS Office Suite.

• Professional demeanor and strong interpersonal skills.

• Successful completion of a background check is required.

• Must have authorization to work in the United States on a full-time, permanent basis without current or future visa sponsorship.

🏝️ Benefits

• Medical, Dental, and Vision insurance.

• 401K company matching.

• Flexible Paid Time Off.

• Paid parental leave.

• HSA/FSA options available.

• Educational reimbursement program.

• Employer-paid EAP & Mental Health services.