State Licensed Physician Advisor

To support evidence-based utilization management, the remote 1099 Contractor Physician Advisor will conduct peer-to-peer discussions with treating providers, review clinical documentation, and evaluate medical necessity determinations while adhering to CMS requirements. Key Responsibilities Conduct scheduled and ad hoc peer-to-peer discussions regarding authorization requests with treating physicians Review clinical documentation and applicable criteria to evaluate medical necessity and appropriate levels of care Document P2P discussions accurately and complete requests within established turnaround times Required Qualifications MD or DO from an accredited medical school Current, unrestricted U.S. medical license Board certification in a relevant clinical specialty preferred Minimum of 5 years of clinical practice experience preferred Experience with utilization management or Medicare Advantage requirements preferred