Physician Advisor – Peer to Peer, Level of Care

🔥 13 minutes ago

🏈 Alabama, Florida, +6 more states – Remote

🏈 Alabama – Remote 🐊 Florida – Remote 🐎 Kentucky – Remote 🌲 North Carolina – Remote 🎸 Mississippi – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

💵 $150.1k - $199.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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 on the appropriateness of requests based on available documentation • Discuss cases with payor medical directors • Address authorization requests, documentation support, evidence-based criteria, and complex clinical evaluations • Review and respond to payors and customers in a timely manner • Engage payor medical directors regarding authorization status supported by documentation • Provide written case analyses and perform reviews across multiple specialties • Serve as a clinical resource to medical and case management staff • Identify, facilitate, and resolve documentation and utilization issues

🎯 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 review authorization denials, documentation, evidence-based criteria, and complex clinical requests across multiple specialties

🏖️ Benefits

• Annual bonus plan at a target of 10.00% • Competitive benefits package • Opportunities 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