Remote Physician Advisor: Payor Peer-to-Peer Reviewer

R1 RCM, Inc.; Lorida (FL); Remote; USD 150,000 - 199,000; Full time

Job summary

R1 RCM Inc. is seeking a Physician Advisor to review payor peer-to-peer cases and advise on authorization, documentation, and case appropriateness across multiple specialties.

This remote role requires strong clinical knowledge and independence in a fast-paced environment. Ideal candidates hold an active MD or DO license with at least three years of post-residency clinical experience, and are capable of collaborating with payor medical directors and medical staff to drive compliant revenue and

Qualifications

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

Responsibilities

• Addresses the following issues: authorization requested, documentation support or lack of support for that authorization, evidence-based criteria for that support, and complex clinical evaluation of the request as a whole.
• Review and respond to the payor and customer in a timely manner.
• Actively engage with payor medical directors to discuss appropriate authorization status as supported by documentation.
• Provide written analysis of the case and perform case reviews across multiple specialties.
• Serve as a clinical resource to medical and case management staff by providing identification, facilitation, and resolution of documentation and utilization issues.

Skills

MD/DO license

Clinical experience

Job description

R1 RCM Inc. is seeking a Physician Advisor to review payor peer-to-peer cases and advise on authorization, documentation, and case appropriateness across multiple specialties.

This remote role requires strong clinical knowledge and independence in a fast-paced environment. Ideal candidates hold an active MD or DO license with at least three years of post-residency clinical experience, and are capable of collaborating with payor medical directors and medical staff to drive compliant revenue and