Physician Advisor - Licensed

Job Summary

To support optimal patient care, the fully remote Physician Advisor - Licensed will perform case reviews, provide clinical consultations, and ensure compliance with medical necessity and utilization management standards while maintaining accountability for case management outcomes.

Key responsibilities

• Conduct timely clinical reviews and provide consultations on complex clinical issues to medical staff
• Maintain accountability for achieving case management outcomes and support documentation and coding improvements
• Participate in ongoing training and education related to Utilization Management and Care Management

Required qualifications

• Board Certified and licensed to practice medicine in the US or 3+ years of active clinical experience in the US
• 3+ years of experience as a Physician Advisor performing Level of Care and Peer to Peer Reviews
• Basic technical skills with Hospital EMRs
• Working knowledge of utilization management, quality improvement, and patient safety
• Familiarity with MCG/InterQual criteria is preferred