Physician Advisor, Utilization & Denials – Peer-to-Peer

Hawaii Pacific Health; Honolulu (HI); On-site; USD 165,000 - 207,000; Full time

Job summary

Hawaii Pacific Health is seeking a Peer to Peer Physician Advisor to provide consultative leadership across utilization management, medical necessity determinations, denial prevention, and revenue cycle performance. This role collaborates with medical staff, case management, CDI, and health plan medical directors to facilitate proper patient status and level-of-care decisions.

Responsibilities include conducting peer-to-peer discussions with health plan directors, educating physicians, ensuring

Qualifications

• MD/DO physician with license to practice in Hawai‘i and current board certification.
• Five (5) years of direct clinical patient care experience.
• Experience with utilization management, medical necessity reviews, and payer interactions.

Responsibilities

• Lead utilization management and medical necessity reviews; support denial prevention and denial management.
• Serve as liaison between medical staff, case management, CDI, revenue cycle leadership and health plan medical directors to determine patient status and level of care.
• Conduct peer-to-peer discussions with health plan medical directors and provide physician education.
• Support regulatory compliance and promote best practices in documentation integrity and utilization management.

Education

Doctorate Degree in Medicine (MD or DO)

Tools

DEA certification

Job description

Hawaii Pacific Health is seeking a Peer to Peer Physician Advisor to provide consultative leadership across utilization management, medical necessity determinations, denial prevention, and revenue cycle performance. This role collaborates with medical staff, case management, CDI, and health plan medical directors to facilitate proper patient status and level-of-care decisions.

Responsibilities include conducting peer-to-peer discussions with health plan directors, educating physicians, ensuring