Remote Physician Advisor: Clinical Review & Appeals

UnitedHealth Group; Newtown Square (Delaware County); Remote; USD 160,000 - 300,000; Full time

Job summary

UnitedHealth Group is seeking a Physician Advisor to partner with providers, case managers, and payors for medical necessity reviews and appeals. You will conduct concurrent peer-to-peer discussions and ensure appropriate patient status determinations across client health systems.

Role emphasizes clinical expertise to support quality outcomes, regulatory compliance, and cost-effective care with remote work within the U.S. Optum Insight functions are highlighted in the role.

Qualifications

• Licensed Physician (MD or DO) with a current, active, unrestricted Medical License in the U.S.
• Current Board Certification
• 3+ years of experience in a hospital-based practice setting
• Demonstrated computer proficiency (MS Office, etc.)
• Willing to work evenings/weekends/holidays as needed
• Willing to work at least 3 holidays per year

Responsibilities

• Provide medical necessity and compliance reviews for client hospitals
• Perform concurrent peer-to-peer reviews with payor medical directors
• Conduct written and verbal appeals
• Support timely, appropriate and cost-effective patient status determinations
• Engage with team members across Physicians Advisors, Nurses, and Administrative staff

Skills

US MD/DO license

Board Certification

MS Office

Education

MD or DO degree

Tools

MS Office

Job description

UnitedHealth Group is seeking a Physician Advisor to partner with providers, case managers, and payors for medical necessity reviews and appeals. You will conduct concurrent peer-to-peer discussions and ensure appropriate patient status determinations across client health systems.

Role emphasizes clinical expertise to support quality outcomes, regulatory compliance, and cost-effective care with remote work within the U.S. Optum Insight functions are highlighted in the role.