Physician Advisor, Payer Peer to Peer

This is a fully remote position, open to applicants in Colorado, +2 more states.

📋 Description

• Assess payor peer-to-peer cases related to authorization denials.

• Determine if the necessary documentation validates the requested admission status, procedure, and care setting.

• Counsel client facilities on the appropriateness of requests based on the documentation provided.

• Engage in discussions with medical directors from the payor side.

• Address authorization requests, documentation support, evidence-based criteria, and complex clinical evaluations.

• Collaborate with attending physicians to discuss appropriate status substantiated by documentation.

• Communicate with utilization review teams and/or case managers at client hospitals concerning case determinations.

• Produce written case analyses and perform reviews across various specialties.

⛳️ Requirements

• Valid, unrestricted MD or DO medical license.

• At least 3+ years of clinical experience after completing residency.

• Strong clinical expertise across diverse clinical areas.

• Capacity to work autonomously with a high level of performance in a dynamic, fast-paced environment.

• Competency in basic computer skills.

• Availability to work during pre-scheduled hours.

• Ability to achieve quality and productivity benchmarks.

🏝️ Benefits

• Eligible to take part in an annual bonus plan targeting 10.00%.

• Competitive benefits package offered.

• Opportunity for continuous learning, cross-group collaboration, and exploration of new career paths.

• Chance to contribute meaningfully, think innovatively, and create impactful work.

• Support for reasonable accommodations for applicants with disabilities.