Remote Physician Advisor: Quality, Compliance & Care

Colorado Psychiatric; Northern (KY); Hybrid; USD 160,000 - 300,000; Full time

Job summary

UnitedHealth Group, via Optum Insight, is seeking a Physician Advisor to partner with providers, case managers, and payors to conduct medical necessity reviews and manage appeals. You will help determine patient status and support cost-effective, high-quality care across client health systems.

The role emphasizes clinical expertise, regulatory compliance, and cross-functional collaboration, with remote work from anywhere in the U.S. and a compensation range published ($160,000–$300,000 annually).

Qualifications

• Licensed Physician with an active, unrestricted Medical License in the U.S.
• Current Board Certification.
• 3+ years of experience in a hospital-based practice setting.
• Proficient with multiple platforms and MS Office Suite.
• Ability to have meaningful conversations with Case Managers and Attending Physicians.
• Willing to work evenings/weekends/holidays as required and at least 3 holidays per year.

Responsibilities

• Provide medical necessity and compliance reviews for client hospitals.
• Conduct concurrent peer-to-peer reviews with payor medical directors.
• Perform written and verbal appeals on behalf of client hospitals.
• Promote regulatory standards and CMS policy adherence for inpatient status decisions.
• Meet performance/quality metrics and collaborate with the care team.

Skills

Communication skills

Team player

Problem solving

Self-motivated

Work independently

Documentation skills

Education

MD or DO with active license

Board Certification

Tools

MS Office Suite

Job description

UnitedHealth Group, via Optum Insight, is seeking a Physician Advisor to partner with providers, case managers, and payors to conduct medical necessity reviews and manage appeals. You will help determine patient status and support cost-effective, high-quality care across client health systems.

The role emphasizes clinical expertise, regulatory compliance, and cross-functional collaboration, with remote work from anywhere in the U.S. and a compensation range published ($160,000–$300,000 annually).