State Licensed Peer Physician

Job Summary

To support peer-to-peer provider discussions in outpatient and long-term care settings, the contract State Licensed Peer Physician will engage in clinical conversations, review medical necessity decisions, and provide clear clinical reasoning while working remotely for a 6-week period starting October 3.

Key responsibilities

• Participate in peer-to-peer calls to review clinical decisions and treatment plans
• Clarify medical necessity decisions using evidence-based guidelines and clinical criteria
• Collaborate with utilization management and care coordination teams on escalated cases

Required qualifications

• MD or DO with an active, unrestricted U.S. medical license
• Board-certified physician
• Strong clinical background with experience in real-world decision-making
• Prior exposure to utilization management or peer-to-peer discussions preferred
• Experience with ambulatory workflows or EMR systems, especially Lumens, is helpful