Remote Physician Advisor - Payor Case Review

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

Benefits offered by this job

Annual bonus 10%

Job summary

R1 RCM Inc. is seeking a Physician Advisor to support our client facilities in navigating compliant revenue by reviewing payor peer-to-peer cases.

You will assess cases where authorization was denied and determine if the documentation supports the admission status, procedure, and care setting requested. You must hold an active MD or DO license and have at least 3 years of clinical experience post-residency.

Qualifications

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

Responsibilities

• Review payor peer-to-peer cases where authorization was denied.
• Evaluate documentation for admission status, procedure, and care setting requested.
• Advise clients on the appropriateness of requests based on available documentation.
• Discuss cases with payor medical directors to determine authorization status.
• Provide written analyses and perform case reviews across multiple specialties.
• Serve as a clinical resource to staff for documentation and utilization issues.

Skills

MD/DO licensure

Clinical experience 3+ years

Education

MD or DO degree

Job description

R1 RCM Inc. is seeking a Physician Advisor to support our client facilities in navigating compliant revenue by reviewing payor peer-to-peer cases.

You will assess cases where authorization was denied and determine if the documentation supports the admission status, procedure, and care setting requested. You must hold an active MD or DO license and have at least 3 years of clinical experience post-residency.