Physician Advisor: Utilization & Appeals Specialist

Xsolis; Franklin (TN); Hybrid; USD 150,000 - 230,000; 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, an AI-driven healthcare technology company based in Franklin, TN, is seeking Physician Advisors to support XPAS client reviews with emphasis on utilization management, CMS rules, and evidence-based assessments. This full-time role focuses on improving hospital efficiency and reducing administrative waste across payer-provider interactions.

Ideal candidates have 5+ years of clinical practice, relevant UM experience, and strong communication and documentation skills.

Qualifications

• Graduate of an accredited medical school.
• 5 years recent clinical practice.
• Utilization management experience preferred.
• Knowledge of federal, state, and payer regulatory requirements.
• Licensed physician without restrictions.
• Excellent verbal and written communication.
• MS Office Suite proficiency.
• Professional demeanor and interpersonal skills.

Responsibilities

• Provide clinical reviews per Managed Care and CMS requirements to assess level of care and length of stay.
• Assist with denial management and the appeals process.
• Determine if standards of quality care are met.
• Educate internal and external staff on regulatory requirements and utilization.
• Maintain documentation of patient care reviews and decisions.
• Contribute to development of XSOLIS appeal operations and analytics.

Skills

Utilization management

Regulatory knowledge

Verbal & written communication

Interpersonal skills

Team collaboration

Education

Graduate of an accredited medical school

Quality & utilization management education

Tools

MS Office Suite

Job description

Xsolis, an AI-driven healthcare technology company based in Franklin, TN, is seeking Physician Advisors to support XPAS client reviews with emphasis on utilization management, CMS rules, and evidence-based assessments. This full-time role focuses on improving hospital efficiency and reducing administrative waste across payer-provider interactions.

Ideal candidates have 5+ years of clinical practice, relevant UM experience, and strong communication and documentation skills.