Remote Physician Advisor: Medical Necessity and Payer Reviews

Sound Physicians; Northern (KY); Hybrid; USD 170.000 - 210.000; Vollzeit

Benefits dieser Stelle

Health Benefits

401k

CME

Productivity-based pay (avg $190k)

Zusammenfassung

Sound Physicians invites physician advisors to join our Advisory Services team in a remote, full-time capacity. The role requires a strong clinical background, experience with medical necessity, and the ability to write clear, evidence-based case reviews for payers and care teams.

You'll collaborate across states to improve outcomes, perform Level of Care determinations and peer-to-peer reviews, and participate in reviews that support regulatory compliance.

Qualifikationen

• MD or DO licensure within the state of employment.
• Board Certification (base specialty) Internal Medicine - Hospital Medicine, Emergency Medicine, Critical Care recognized by ABMS or ABQAURP.
• Utilization-specific training from ABQAURP 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.

Aufgaben

• Holistic Case Review: direct review of the medical record by licensed physicians leading to all-inclusive determinations.
• Level of Care (LOC) determinations.
• Peer-to-Peer reviews.

Kenntnisse

EMR competence

Written English communication

Investigative mindset

Ausbildung

MD/DO degree

ABMS/ABQAURP board certification

Tools

EMR systems

Jobbeschreibung

Sound Physicians invites physician advisors to join our Advisory Services team in a remote, full-time capacity. The role requires a strong clinical background, experience with medical necessity, and the ability to write clear, evidence-based case reviews for payers and care teams.

You'll collaborate across states to improve outcomes, perform Level of Care determinations and peer-to-peer reviews, and participate in reviews that support regulatory compliance.