Physician Advisor

. Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals .

Posted 10/19/2026full-timeRemote • Illinois • United StatesJuniorWebsite

Key responsibilities & impact

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 the Physician Advisory team, hospital physicians, care coordination, and utilization management staff to promote evidence-based care and documentation
Assist in improving documentation related to ICD coding, severity of illness, risk of mortality, and DRG assignment
Keep current with CMS and MCG evidence-based guidelines
Maintain compliance with legal, regulatory, accreditation, and payer partner requirements
Meet productivity and quality standards within established time requirements
Attend required training and meetings
Participate in peer review as needed
Protect and disclose patients’ PHI in accordance with HIPAA standards
Limit PHI access to the minimum necessary for assigned duties
Perform other duties as assigned

What you’ll need

MD or DO with an active, unrestricted medical license
US Board Certified in a recognized specialty
Minimum of 1 year of payer or provider-side utilization review, or active ACPA and/or ABQUARP certification
Basic technical skills with hospital EMRs
Strong knowledge of utilization management, medical necessity, and payer regulations
Familiarity with MCG/InterQual placement status criteria preferred
Membership in the American College of Physician Advisors (ACPA) preferred
Ability to effectively present information, both formally and informally
Proficiency in Microsoft Office Suite
Strong interpersonal and communication skills
Strong problem-solving and creative skills, with sound judgment and ability to make decisions based on accurate and timely analyses
High integrity and dependability, with a strong sense of urgency and results orientation
Excellent written and verbal communication skills
Ability to use a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
Ability to follow directions, collaborate with others, and handle stress

Comp & perks

Multifactor authentication and security support via a required smartphone or electronic device
Compliance with HIPAA, information security, legal, regulatory, accreditation, and payer partner policies
Equal employment opportunity protections