Remote Physician Advisor: Payer Peer Review

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

Benefits offered by this job

Annual bonus plan

Job summary

R1 RCM Inc. is seeking a Physician Advisor for a remote US-based role to guide compliant revenue by reviewing payor peer-to-peer denial cases and advising on documentation adequacy for admissions, procedures, and care settings. The role requires MD/DO licensure and substantial clinical experience.

You will discuss cases with payor medical directors, provide written analyses, and serve as a clinical resource to ensure appropriate utilization decisions in a fast-paced environment.

Qualifications

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

Responsibilities

• Review payor peer-to-peer cases denied authorization, evaluating documentation for admission status, procedure, and care setting.
• Advise on the appropriateness of the authorization based on available documentation and discuss cases with payor medical directors.
• Provide written analysis of cases and perform reviews across multiple specialties.
• Serve as a clinical resource to medical and case management staff by identifying, facilitating, and resolving documentation and utilization issues.
• Respond to payor and customer in a timely manner.

Skills

MD/DO licensure

Clinical experience 3+ years

Education

MD or DO (allopathic/osteopathic)

Job description

R1 RCM Inc. is seeking a Physician Advisor for a remote US-based role to guide compliant revenue by reviewing payor peer-to-peer denial cases and advising on documentation adequacy for admissions, procedures, and care settings. The role requires MD/DO licensure and substantial clinical experience.

You will discuss cases with payor medical directors, provide written analyses, and serve as a clinical resource to ensure appropriate utilization decisions in a fast-paced environment.