Remote Physician Advisor: Payor Peer-to-Peer Reviews

R1 RCM, Inc.; South Carolina; Remote; USD 150,000 - 199,000; Full time

Job summary

R1 RCM, Inc. is seeking a Physician Advisor to support client facilities by reviewing payor peer-to-peer cases and advising on authorization decisions in a remote capacity.

You must hold an active MD or DO license and have at least 3 years of clinical experience post-residency. The role involves evaluating documentation, discussing cases with payor medical directors, and providing written analyses across multiple specialties, contributing to compliant revenue outcomes.

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 licensure

Job description

R1 RCM, Inc. is seeking a Physician Advisor to support client facilities by reviewing payor peer-to-peer cases and advising on authorization decisions in a remote capacity.

You must hold an active MD or DO license and have at least 3 years of clinical experience post-residency. The role involves evaluating documentation, discussing cases with payor medical directors, and providing written analyses across multiple specialties, contributing to compliant revenue outcomes.