California Licensed Physician Advisor

Job Summary

To enhance patient care and optimize service utilization, the part-time California Licensed Physician Advisor will perform medical necessity reviews, lead concurrent review activities, and serve as a clinical leader while working remotely.

Key responsibilities

• Conduct medical necessity utilization reviews for inpatient, post-acute, and outpatient cases in accordance with UM guidelines
• Lead concurrent review activities, including rounds and peer-to-peer discussions, to improve clinical and efficiency outcomes
• Act as a liaison between medical staff and the utilization review team to promote clinically necessary and efficient care utilization

Required qualifications

• Minimum of 3 years of experience in clinical care, quality management, or utilization/case management
• Completion of medical school and specialty residency, preferably in internal medicine
• Current, non-restricted California medical license
• Utilization management experience and knowledge of healthcare delivery systems
• Ability to build rapport with medical staff and management leadership