Physician Advisor: Utilization Review & Clinical Guidance

Med--metrix; Chicago (IL); Remote; USD 180,000 - 280,000; Full time

Job summary

Med-Metrix is seeking a Physician Advisor to provide physician-to-physician reviews, clinical guidance and escalation support, promoting evidence-based practices and appropriate resource utilization. The role focuses on medical necessity, utilization review and collaboration with care teams to optimize documentation and decision-making.

The ideal candidate holds an MD/DO with active license, US Board Certification, and experience in payer or provider-side utilization review, with strong

Qualifications

• MD or DO with active, unrestricted license.
• US Board Certification in a recognized specialty.
• 1 year payer or provider-side utilization review experience.
• Strong knowledge of utilization management and payer regulations.
• Familiarity with MCG/InterQual placement criteria preferred.

Responsibilities

• Conduct physician-to-physician reviews for medical necessity and denial prevention.
• Support utilization review and case management with complex decisions.
• Communicate with hospital physicians and staff to promote evidence-based care and documentation.
• Maintain documentation for ICD coding, severity of illness, and DRG assignment.
• Stay current with CMS and MCG guidelines to support utilization decisions.
• Ensure compliance with HIPAA and other regulatory requirements.
• Meet productivity and quality standards within established time requirements.
• Attend required training and meetings; participate in peer review as needed.

Skills

MD/DO

Board Certified

ACPA

ABQUARP

Active medical license

EMR proficiency

Utilization management

MS Office

Communication skills

Problem solving

Education

MD/DO degree

Medical license active

Tools

EMR systems

Job description

Med-Metrix is seeking a Physician Advisor to provide physician-to-physician reviews, clinical guidance and escalation support, promoting evidence-based practices and appropriate resource utilization. The role focuses on medical necessity, utilization review and collaboration with care teams to optimize documentation and decision-making.

The ideal candidate holds an MD/DO with active license, US Board Certification, and experience in payer or provider-side utilization review, with strong