Senior Physician Advisor – P2P Medical Reviewer

Harris Jones Staffing Recruiting Llc; Eagan (MN); On-site; USD 150,000 - 190,000; Full time

Job summary

HJ STAFFING is seeking two Physician Advisors – Peer-to-Peer (P2P Medical Reviewers) to conduct clinical discussions with treating providers regarding utilization management determinations. You will apply Medicare/CMS requirements, health plan policies, and clinical judgment to determine appropriate levels of care and medical necessity, supporting timely, evidence-based decisions.

Responsibilities include leading P2P reviews, evaluating cases, applying regulatory criteria, collaborating with

Qualifications

• MD or DO from an accredited medical school.
• Active, current, and unrestricted U.S. medical license.
• Board certification in Internal Medicine, Family Medicine, Emergency Medicine, or equivalent.
• 5+ years of clinical practice experience.
• Utilization management or physician advisory experience preferred.
• Strong familiarity with Medicare Advantage, CMS criteria, MCG/InterQual, NCD/LCD, and the Two-Midnight rule.
• Exceptional physician-to-physician communication and professional collaboration.

Responsibilities

• Lead Peer-to-Peer discussions with treating physicians and other providers regarding utilization requests.
• Review member documentation and criteria to determine medical necessity and level of care.
• Apply CMS and health plan criteria to support appropriate determinations.
• Engage clinicians professionally, consider new information, and adjust determinations as needed.
• Document discussions, rationale, and outcomes per regulatory timelines with HIPAA compliance.
• Escalate complex cases to Medical Directors or clinical leadership.
• Identify trends and opportunities for provider education and process improvement.

Skills

Physician communication

Regulatory knowledge

Clinical judgment

HIPAA compliance

Education

MD/DO

Job description

HJ STAFFING is seeking two Physician Advisors – Peer-to-Peer (P2P Medical Reviewers) to conduct clinical discussions with treating providers regarding utilization management determinations. You will apply Medicare/CMS requirements, health plan policies, and clinical judgment to determine appropriate levels of care and medical necessity, supporting timely, evidence-based decisions.

Responsibilities include leading P2P reviews, evaluating cases, applying regulatory criteria, collaborating with