Provides remote physician advisor reviews focused on medical necessity, level-of-care determinations, and peer-to-peer discussions across partner hospitals. The role centers on clinically supported case review for inpatient utilization, documentation accuracy, and care coordination, with work expected to be clearly understood by case managers, bedside clinicians, and payers. Physicians also apply Medicare regulations and commercial payer guidelines while collaborating across multiple states.
Key Responsibilities
- Conduct direct medical record reviews to support medical necessity and level-of-care determinations.
- Provide peer-to-peer reviews with payers and/or hospital stakeholders.
- Assess documentation accuracy and identify opportunities for clinical documentation improvement.
- Apply Medicare regulations and commercial payer guidelines during case review.
- Support regulatory compliance and best practices for care coordination.
- Collaborate with case managers, bedside providers, and partner hospitals across multiple states.
- Use EMR tools to complete clinically supported written case reviews.
Required
- MD or DO degree.
- Active licensure in the state of employment.
- Board certification in Internal Medicine, Hospital Medicine, Emergency Medicine, or Critical Care recognized by ABMS or ABQAURP.
- Ability to work in the United States.
- Utilization-specific training from ABQAURP or equivalent within 12 months of hire.
- Education on application of medical necessity criteria within 3 months of hire.
Preferred
- 3 years of post-residency experience as an advisor.
Benefits & Perks
- Remote work arrangement.
- Full-time schedule.
- Health benefits.
- 401(k) plan.
- CME support.
- Productivity-based compensation with per-case pay structure.