State Licensed Physician Advisor
Job Summary
To enhance healthcare services, the full-time remote State Licensed Physician Advisor will conduct comprehensive case reviews, determine levels of care, and perform peer-to-peer reviews, ensuring compliance with Medicare regulations and payer guidelines.
Key Responsibilities:
- Conduct holistic case reviews to assess medical necessity and documentation accuracy
- Make Level of Care (LOC) determinations based on medical records
- Perform peer-to-peer reviews with healthcare providers and case managers
Required Qualifications:
- MD or DO Licensure within the state of employment
- Board Certification in Internal Medicine, Emergency Medicine, or Critical Care recognized by ABMS or ABQAURP
- Utilization-specific training from ABQAURP or equivalent within 12 months of hire
- Education on application of medical necessity criteria within 3 months of hire
- 3 years post-residency experience as an advisor is strongly preferred
Complete Job Description
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