Physician Advisor Peer to Peer / Level of Care

R1 RCM•Remote, GA, IN

17d•$150,075 - $199,070•Remote

About The Position

The Physician Advisor helps client facilities navigate compliant revenue by reviewing payor peer-to-peer cases involving denied authorizations. The role evaluates whether documentation supports the requested admission status, procedure, and care setting, advises clients on the appropriateness of requests, and discusses cases with payor medical directors. The Physician Advisor performs case reviews across multiple specialties, provides written case analyses, and serves as a clinical resource to medical and case management staff. This remote position requires strong clinical knowledge across multiple areas, independent work, high performance in a fast-changing environment, and basic computer proficiency.

Requirements

Active, unrestricted MD or DO medical licensure.
At least 3 years of clinical experience after completion of residency.
Strong clinical knowledge across multiple clinical areas.
Ability to work independently and perform at a high level in a rapidly changing, fast-paced environment.
Proficiency in basic computer skills.

Responsibilities

Evaluate denied authorization cases to determine whether documentation supports the requested admission status, procedure, and care setting.
Assess the authorization request using available documentation and evidence-based criteria, including complex clinical evaluation of the request as a whole.
Review and respond to payors and customers in a timely manner.
Engage with payor medical directors to discuss appropriate authorization status as supported by documentation.
Provide written analysis of cases and perform reviews across multiple specialties.
Serve as a clinical resource to medical and case management staff by identifying, facilitating, and resolving documentation and utilization issues.