To enhance healthcare services, the full-time remote State Licensed Physician Advisor will conduct comprehensive case reviews, determine levels of care, and perform peer-to-peer reviews, ensuring compliance with Medicare regulations and payer guidelines. Key Responsibilities: Conduct holistic case reviews to assess medical necessity and documentation accuracy Make Level of Care (LOC) determinations based on medical records Perform peer-to-peer reviews with healthcare providers and case managers Required Qualifications: MD or DO Licensure within the state of employment Board Certification in Internal Medicine, Emergency Medicine, or Critical Care recognized by ABMS or ABQAURP Utilization-specific training from ABQAURP or equivalent within 12 months of hire Education on application of medical necessity criteria within 3 months of hire 3 years post-residency experience as an advisor is strongly preferred
State Licensed Physician Advisor in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.