Remote Physician Advisor: Case Reviews & Payer Compliance

PracticeLink, Ltd.; California (MO); Remote; USD 120,000 - 190,000; Full time

Benefits offered by this job

Health Benefits

401k

CME

Productivity-based pay

Job summary

PracticeLink, Ltd. is seeking a Physician Advisor for Advisory Services to work remotely in a full-time capacity. The role focuses on holistic case reviews, medical necessity determinations, and ensuring compliance across payer guidelines.

The successful candidate will have an MD or DO licensure, ABMS/ABQAURP board certification, and experience with EMR systems. Strong written English, investigative mindset, and the ability to collaborate with case managers, providers, and payers are essential.

Qualifications

• MD or DO licensure in the state of employment.
• Board Certification (Internal Medicine / Emergency Medicine / Critical Care) recognized by ABMS or ABQAURP.
• Utilization-specific training from ABQAURP (or equivalent) within 12 months of hire.
• Education on application of medical necessity criteria within 3 months of hire.
• 3 years post-residency experience as an advisor - strongly preferred.
• Authorized to work in the United States.

Responsibilities

• Holistic Case Review: direct review of medical records leading to determinations of medical necessity, documentation accuracy, and coordination improvements.
• Level of Care (LOC) determinations.
• Peer-to-Peer reviews.
• Complete 10 LOC shifts per month (8:00 AM–6:00 PM EST) and 80 Peer-to-Peers per month.
• LOC determinations from 6:00 AM to 2:00 PM ET, Mon-Fri, 20 shifts per month.
• Peer-to-Peer reviews 8:00 AM–5:00 PM EST, Mon-Fri, 140 Peer-to-Peers per month.

Education

MD/DO Licensure

Board Certification (Internal Medicine / Emergency Medicine / Critical Care)

ABQAURP Utilization Training or equivalent

Education on medical necessity criteria

3 years post-residency experience as an advisor

Authorized to work in United States

Tools

EMR systems

Job description

PracticeLink, Ltd. is seeking a Physician Advisor for Advisory Services to work remotely in a full-time capacity. The role focuses on holistic case reviews, medical necessity determinations, and ensuring compliance across payer guidelines.

The successful candidate will have an MD or DO licensure, ABMS/ABQAURP board certification, and experience with EMR systems. Strong written English, investigative mindset, and the ability to collaborate with case managers, providers, and payers are essential.