California Licensed Physician Advisor

Job Summary

To enhance healthcare service utilization, the part-time California Licensed Physician Advisor will provide clinical oversight, support care management operations, and educate medical staff on regulatory compliance and documentation practices while working remotely.

Key responsibilities:

• Provide clinical oversight and support for care management operations, including clinical denials and appeals
• Educate physicians and clinical teams on regulatory requirements and alternative levels of care to improve patient outcomes
• Facilitate accurate clinical documentation to ensure compliance with coding guidelines and improve DRG assignments

Required qualifications:

• Doctorate from an accredited medical school (MD or DO)
• Unrestricted medical license in the state of residence
• Minimum of 3 years of relevant experience in healthcare delivery or case management
• Comprehensive knowledge of utilization review and healthcare reimbursement systems
• Proficient understanding of coding and DRG assignment processes preferred