Remote Physician Advisor: Utilization Management & Appeals

Ladders; United States; Remote; USD 198,000 - 297,000; Full time

Benefits offered by this job

Comprehensive healthcare package

Flexible work-life balance options

Investment in professional development

Tuition reimbursement for further教育

Quarterly and annual recognition and 1

Job summary

Client is seeking a Physician Advisor to join the Hospitals & Medical Centers space in a remote capacity. The role guides utilization management decisions supporting inpatient care, observation review, and medical necessity determinations.

You will partner with medical staff, leadership, and payor medical directors to strengthen clinical collaboration and resolve coverage and appeals issues. This position supports quality, compliance, and efficient care delivery across the hospital setting, with

Qualifications

• MD/DO credential required for the role.
• 5-7 years of utilization management experience.
• Advanced proficiency in AI applications for business outcomes.
• Strong communication skills for executive-level interactions.
• Ability to travel for onsite engagements as needed.

Responsibilities

• Render status determinations for hospitalized patients.
• Conduct peer-to-peer reviews with payors' medical directors.
• Review short inpatient stays and observation patients daily.
• Build relationships with medical staff and leadership to support utilization management.
• Attend utilization management committees as a subject matter expert.
• Assist with denials and appeals processes.
• Educate medical staff on utilization management topics.

Skills

Utilization management experience

AI for business outcomes

Executive communication

Travel readiness

Education

MD/DO

Job description

Client is seeking a Physician Advisor to join the Hospitals & Medical Centers space in a remote capacity. The role guides utilization management decisions supporting inpatient care, observation review, and medical necessity determinations.

You will partner with medical staff, leadership, and payor medical directors to strengthen clinical collaboration and resolve coverage and appeals issues. This position supports quality, compliance, and efficient care delivery across the hospital setting, with