Illinois Licensed Physician Advisor

Job Summary

Providing clinical guidance and support, the part-time Illinois Licensed Physician Advisor will conduct physician-to-physician reviews and assist in utilization management while working remotely.

Key responsibilities

• Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals
• Support utilization review and case management teams with complex clinical decision-making
• Communicate with various healthcare teams to promote best practices for evidence-based care and documentation

Required qualifications

• MD or DO with an active, unrestricted medical license
• US Board Certified in a recognized specialty
• Minimum of 1 year of payor or provider-side utilization review experience or active ACPA and/or ABQUARP certification
• Strong knowledge of utilization management, medical necessity, and payer regulations
• Proficiency in Microsoft Office Suite