California Licensed Physician Advisor

Job Summary

To enhance patient care quality, the part-time California Licensed Physician Advisor will manage clinical reviews for medical necessity and compliance, collaborating with healthcare teams remotely.

Key responsibilities

• Processes second level reviews in compliance with Medicare/CMS guidelines for various levels of care
• Acts as a liaison between medical staff, utilization review, and third-party payers to ensure appropriate medical care classifications
• Oversees case management protocols and provides clinical leadership for quality improvement projects

Required qualifications

• Minimum of 3 years of experience in clinical care, quality management, or utilization and case management
• Completion of medical school and specialty residency, preferably in internal medicine
• Current, non-restricted licensure for clinical practice in California
• Knowledge of healthcare delivery systems and reimbursement issues
• Ability to communicate effectively and build rapport with medical staff and management