Pennsylvania Licensed Physician Advisor

Job Summary

Seeking a collaborative and experienced Pennsylvania Licensed Physician Advisor, this full-time remote position will manage utilization management and physician engagement to ensure high-quality, compliant patient care while partnering with hospital leadership and medical staff.

Key Responsibilities

• Provide guidance on patient status, medical necessity, and level of care, including secondary reviews and observation cases
• Support utilization review and denial management activities, including peer-to-peer discussions and appeals with third-party payers
• Collaborate with physicians and hospital leadership to improve documentation and resource utilization while ensuring compliance with regulations

Required Qualifications

• Graduate of an accredited School of Medicine (Allopathic/Osteopathic)
• Possess or able to obtain an unrestricted PA Medical License
• Board Eligible or Board Certified
• Minimum 5 years' clinical experience in a hospital setting
• Solid foundation in utilization management and hospital operations