Physician Utilization Advisor (Remote)

HURC; United States; On-site; USD 120,000 - 180,000; Full time

Job summary

HURC in the United States is seeking a Physician Advisor to lead physician-to-physician reviews, provide clinical guidance, and support education and escalation processes while promoting evidence-based practices and appropriate resource utilization.

You will collaborate with utilization review, case management, HIM, and revenue cycle teams to ensure medical necessity, admission status, and regulatory compliance.

Qualifications

• MD/DO licensed with board certification in a recognized specialty.
• Clinical governance and regulatory knowledge are essential.
• Experience with CMS guidelines and payer regulations preferred.

Responsibilities

• Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention.
• Support utilization review and case management with complex clinical decisions.
• Ensure admission status determinations align with CMS and payer guidelines.
• Provide oversight on length of stay, care progression, and discharge planning.
• Assist with audits (RAC, MAC) and responses as needed.
• Collaborate with HIM/CDI teams to improve documentation quality.

Skills

Utilization management

Regulatory knowledge

Peer communication

Clinical judgment

Education

MD/DO

Job description

HURC in the United States is seeking a Physician Advisor to lead physician-to-physician reviews, provide clinical guidance, and support education and escalation processes while promoting evidence-based practices and appropriate resource utilization.

You will collaborate with utilization review, case management, HIM, and revenue cycle teams to ensure medical necessity, admission status, and regulatory compliance.