AI-Driven Physician Advisor: Utilization & Appeals

Xsolis, Inc; United States; Remote; USD 150,000 - 190,000; Full time

Benefits offered by this job

401K match

Flexible PTO

Paid parental leave

HSA/FSA options

Educational reimbursement

EAP & Mental Health services

Job summary

XSOLIS is seeking a Physician Advisor to provide concurrent review and appeal support for its XPAS client base. You will apply utilization management expertise, review cases for level of care, and help ensure compliance with CMS and state regulations.

This full-time role involves collaborating with care management and providers, documenting decisions, and contributing to the evolution of XSOLIS's clinical analytics platform. Travel to TN for training is required.

Qualifications

• Graduate of an accredited medical school.
• 5 years of recent experience in clinical practice.
• Licensed physician without restrictions.
• Knowledge of federal, state, and payer regulatory requirements.

Responsibilities

• Provide clinical reviews in accordance with Managed Care and CMS regulatory requirements.
• Assist with level of care and length of stay management.
• Participate in concurrent and retrospective appeal peer-review processes.
• Educate internal and external staff on regulatory requirements and appropriate utilization.

Skills

Utilization management

Regulatory knowledge

Clinical documentation

Communication skills

Education

MD degree

Quality/utilization management education

Tools

MS Office Suite

Job description

XSOLIS is seeking a Physician Advisor to provide concurrent review and appeal support for its XPAS client base. You will apply utilization management expertise, review cases for level of care, and help ensure compliance with CMS and state regulations.

This full-time role involves collaborating with care management and providers, documenting decisions, and contributing to the evolution of XSOLIS's clinical analytics platform. Travel to TN for training is required.