Remote Physician Advisor: Clinical Review & Care Quality

ISHE; Northern (KY); Hybrid; USD 160,000 - 300,000; Full time

Job summary

UnitedHealth Group seeks a Physician Advisor to collaborate with providers, case managers, and payors on medical necessity reviews and appeals. The role supports quality outcomes, compliance, and cost-efficient care across client health systems.

You will perform concurrent peer-to-peer discussions with payor medical directors and ensure appropriate patient status determinations while meeting performance and service standards. This is a remote, full-time position with holiday coverage as needed.

Qualifications

• Licensed Physician (MD or DO) with an active U.S. medical license.
• Current Board Certification.
• 3+ years in a hospital-based practice setting.
• Proficient with multiple platforms and MS Office Suite.
• Ability to have meaningful discussions with Case Managers and Attending Physicians.
• Willing to work evenings/weekends/holidays and at least 3 holidays per year.

Responsibilities

• Provide medical necessity and compliance reviews for client hospitals.
• Conduct concurrent peer-to-peer reviews with payor medical directors.
• Manage written and verbal appeals for client hospitals.
• Support quality outcomes, regulatory compliance, and cost-effective care across client health systems.
• Engage with a team of Physicians Advisors, Nurses, and Administrative staff to respond to requests promptly.

Skills

Communication

Team player

Problem solving

Documentation

Independent work

Self-motivated

Education

MD or DO license

Board Certification

Tools

MS Office Suite

Job description

UnitedHealth Group seeks a Physician Advisor to collaborate with providers, case managers, and payors on medical necessity reviews and appeals. The role supports quality outcomes, compliance, and cost-efficient care across client health systems.

You will perform concurrent peer-to-peer discussions with payor medical directors and ensure appropriate patient status determinations while meeting performance and service standards. This is a remote, full-time position with holiday coverage as needed.