Remote Physician Advisor — hospital utilization & appeals

Texas Health Institute; Northern (KY); Hybrid; USD 160,000 - 300,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

401k contribution

Equity stock purchase

Job summary

UnitedHealth Group is seeking a Physician Advisor to partner with providers and payors to conduct medical necessity reviews, facilitate peer-to-peer discussions, manage appeals, and determine patient status. This role supports quality outcomes, compliance, and cost-effective care across client health systems.

The position offers the chance to apply clinical expertise to improve care and work in a flexible remote environment across the United States.

Qualifications

• Licensed MD or DO with active U.S. medical license.
• Board certification in a medical specialty.
• 3+ years hospital-based practice experience.

Responsibilities

• Perform medical necessity reviews for client hospitals.
• Conduct concurrent peer-to-peer reviews with payor medical directors.
• Handle written and verbal appeals for patient status determinations.
• Participate in regulatory alignment and CMS policy adherence.
• Engage with hospital teams to meet performance and quality metrics.

Skills

Medical knowledge

Communication

Team collaboration

Education

MD/DO license

Tools

EHR proficiency

Job description

UnitedHealth Group is seeking a Physician Advisor to partner with providers and payors to conduct medical necessity reviews, facilitate peer-to-peer discussions, manage appeals, and determine patient status. This role supports quality outcomes, compliance, and cost-effective care across client health systems.

The position offers the chance to apply clinical expertise to improve care and work in a flexible remote environment across the United States.