Remote Physician Advisor: Denials & Utilization Review

R1 RCM Holdco Inc.; Georgia; Hybrid; USD 150,000 - 199,000; Full time

Job summary

R1 RCM Inc. is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups.

As our Physician Advisor, you will review payor-denied cases, evaluate documentation for authorization, and advise payor medical directors on the appropriate status.

This remote role requires an active MD or DO license and at least 3 years of clinical experience; a 10% annual bonus plan is available.

Qualifications

• Active, unrestricted MD or DO medical licensure.
• Minimum 3+ years of clinical experience post-residency completion.

Responsibilities

• Review payor peer-to-peer cases for authorization.
• Evaluate documentation for admission status, procedures, and care setting requested.
• Advise clients on appropriateness of requests based on documentation and evidence-based criteria.
• Discuss cases with payor medical directors to determine proper authorization status.
• Provide written analysis and perform case reviews across multiple specialties.

Skills

MD/DO license

Clinical experience 3+ years

Job description

R1 RCM Inc. is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups.

As our Physician Advisor, you will review payor-denied cases, evaluate documentation for authorization, and advise payor medical directors on the appropriate status.

This remote role requires an active MD or DO license and at least 3 years of clinical experience; a 10% annual bonus plan is available.