Physician Utilization Review Expert

Alpheva; United States; Remote; USD 248,000 - 379,000; Part time

Job summary

Alpheva seeks physicians for remote, project-based contract work reviewing medical determinations. This role requires active US medical licensure, board certification, and substantial post-residency experience. You will assess AI-generated determinations against clinical criteria and escalate cases as needed.

Pay is $180–$275 per hour, with payout methods not yet published. The network launched in Sep 2026; confirm first payment before scaling up.

Qualifications

• MD or DO with active or recently active US medical licensure.
• Board certification and 7+ years of post-residency clinical experience.
• Utilization review, physician-advisor, payer, or hospital case-management experience preferred.

Responsibilities

• Review medical-necessity, level-of-care, utilization-management, and physician-advisor reasoning using de-identified clinical cases.
• Evaluate whether AI-generated determinations accurately connect clinical facts, treatment intensity, expected course, and applicable review criteria.
• Identify missing documentation, unsafe assumptions, inappropriate status recommendations, and cases that require peer-to-peer or specialist escalation.
• Explain corrections using clear physician reasoning while preserving uncertainty and avoiding unsupported clinical conclusions.

Skills

Utilization review experience

Physician-advisor

Payer / hospital case-management

Education

MD/DO with active US medical license

Board certification

Job description

Review medical-necessity, level-of-care, utilization-management, and physician-advisor reasoning using de-identified clinical cases.

Evaluate whether AI-generated determinations accurately connect clinical facts, treatment intensity, expected course, and applicable review criteria.

Identify missing documentation, unsafe assumptions, inappropriate status recommendations, and cases that require peer-to-peer or specialist escalation.

Explain corrections using clear physician reasoning while preserving uncertainty and avoiding unsupported clinical conclusions.

Remote, project-based contract work. Scope and hours depend on project matching; the listed hourly range applies to matched work.

Requirements

• MD or DO with active or recently active US medical licensure
• Board certification and 7+ years of post-residency clinical experience
• Utilization review, physician-advisor, payer, or hospital case-management experience preferred

Pay

$180-$275/hr

Alpheva is a new expert network (launched September 2026); payout methods are not published yet, so confirm your first payment before scaling up.