Physician Advisor, Payer Peer to Peer

🔥 1 hour ago

⛰️ Colorado, Pennsylvania, +1 more states – Remote

⛰️ Colorado – Remote 🔔 Pennsylvania – Remote ⛷️ Utah – Remote

💵 $150.1k - $199.1k / year

⏱ Part Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

R1 RCM

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2017

💼 Consulting

📦 Logistics

🏥 Healthcare

💰 Private Equity Round on 2024-07

Consulting • Logistics • Healthcare

R1 RCM is a leading provider of revenue cycle management solutions for the healthcare industry. With an emphasis on maximizing financial performance and optimizing patient care, R1 offers a comprehensive platform that integrates data analytics, intelligent technologies, and deep expertise in revenue cycle management. The company assists healthcare providers—ranging from hospitals and health systems to physician and specialty care practices—in capturing revenue opportunities, improving payer and patient cash flows, and ensuring compliance with government regulations. R1 is committed to driving cost reductions and revenue improvements while enhancing the patient experience. Their suite of services includes revenue recovery, clinical integrity, and regulatory navigation, making them a trusted partner for many top healthcare providers.

📋 Description

• Review payor peer-to-peer cases for authorization denials • Evaluate whether proper documentation supports the requested admission status, procedure, and care setting • Advise client facilities regarding appropriateness of requests based on available documentation • Discuss cases with medical directors from the payor side • Address authorization requests, documentation support, evidence-based criteria, and complex clinical evaluations • Engage with attending physicians to discuss appropriate status supported by documentation • Contact utilization review teams and/or case managers at client hospitals regarding case determinations • Provide written case analyses and conduct reviews across multiple specialties

🎯 Requirements

• Active, unrestricted MD or DO medical licensure • Minimum 3+ years of clinical experience post-residency completion • Strong clinical knowledge across multiple clinical areas • Ability to work independently with a high level of performance in a rapidly changing, fast-paced environment • Proficiency in basic computer skills • Ability to work during pre-scheduled hours • Ability to meet quality and productivity standards

🏖️ Benefits

• Eligible to participate in annual bonus plan at a target of 10.00% • Competitive benefits package • Opportunity to constantly learn, collaborate across groups and explore new career paths • Opportunity to contribute, think boldly and create meaningful work • Reasonable accommodation support for applicants with disabilities