Physician Advisor – Peer to Peer, Level of Care

This is a fully remote position, open to applicants in Alabama, +7 more states.

📋 Description

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

• Determine if the appropriate documentation backs the requested admission status, procedure, and care setting.

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

• Engage in discussions with payor medical directors regarding cases.

• Handle authorization requests, documentation support, evidence-based criteria, and intricate clinical evaluations.

• Review and reply to payors and clients promptly.

• Collaborate with payor medical directors on authorization status grounded in documentation.

• Deliver written case analyses and conduct reviews across various specialties.

• Act as a clinical resource for medical and case management teams.

• Identify, facilitate, and resolve issues related to documentation and utilization.

⛳️ Requirements

• Possession of an active, unrestricted MD or DO medical license.

• At least 3 years of clinical experience following the completion of residency.

• Robust clinical knowledge across diverse clinical fields.

• Capability to operate independently with a high level of efficiency in a dynamic, fast-paced environment.

• Competence in basic computer skills.

• Ability to analyze authorization denials, documentation, evidence-based criteria, and complex clinical requests across various specialties.

🏝️ Benefits

• Annual bonus plan with a target of 10.00%.

• Competitive benefits package.

• Opportunities for continuous learning, collaboration across teams, and exploration of new career paths.

• Chance to contribute, think innovatively, and produce meaningful work.

• Reasonable accommodation support available for applicants with disabilities.