Providing clinical guidance and support, the part-time Illinois Licensed Physician Advisor will conduct physician-to-physician reviews and assist in utilization management while working remotely. Key responsibilities Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals Support utilization review and case management teams with complex clinical decision-making Communicate with various healthcare teams to promote best practices for evidence-based care and documentation Required qualifications MD or DO with an active, unrestricted medical license US Board Certified in a recognized specialty Minimum of 1 year of payor or provider-side utilization review experience or active ACPA and/or ABQUARP certification Strong knowledge of utilization management, medical necessity, and payer regulations Proficiency in Microsoft Office Suite
Illinois Licensed Physician Advisor in workfromhome at Unknown Company
This position is listed as part time and able to be worked remotely.