State Licensed Physician Advisor

Job Summary

To support evidence-based utilization management, the remote 1099 Contractor Physician Advisor will conduct peer-to-peer discussions with treating providers, review clinical documentation, and evaluate medical necessity determinations while adhering to CMS requirements.

Key Responsibilities

• Conduct scheduled and ad hoc peer-to-peer discussions regarding authorization requests with treating physicians
• Review clinical documentation and applicable criteria to evaluate medical necessity and appropriate levels of care
• Document P2P discussions accurately and complete requests within established turnaround times

Required Qualifications

• MD or DO from an accredited medical school
• Current, unrestricted U.S. medical license
• Board certification in a relevant clinical specialty preferred
• Minimum of 5 years of clinical practice experience preferred
• Experience with utilization management or Medicare Advantage requirements preferred