Physician Advisor Peer to Peer / Level of Care
Core
Review denied payor peer-to-peer cases to evaluate documentation and advise on the appropriateness of admission status, procedures, and care settings based on clinical evidence.
Role type
Senior clinical physician advisor (utilization review)
Builds
Compliant revenue pathways for hospitals, health systems, and medical groups
Domain
Healthcare revenue cycle management
Required skills
Active unrestricted MD or DO licensure, 3+ years post-residency clinical experience, complex clinical evaluation, evidence-based criteria analysis, independent work
Preferred skills
Proficiency in basic computer skills, ability to work in fast-paced environment
Technologies
None stated
Responsibilities
Review and respond to payor and customer requests regarding authorization status, engage with payor medical directors to discuss authorization appropriateness, provide written analysis of cases across multiple specialties, serve as a clinical resource to resolve documentation and utilization issues
Seniority
Senior, hands-on IC