United States
Remote only
This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Physician Advisor Lead based in the United States.
This is an opportunity for an experienced physician to combine clinical expertise with leadership, mentorship, and operational excellence in a remote healthcare environment. You will guide a team of Physician Advisors while maintaining an active clinical workload and supporting complex utilization management cases. The role focuses on improving medical necessity determinations, peer-to-peer reviews, denial prevention, and communication between healthcare providers and payers. You will establish consistent clinical standards, strengthen quality assurance, and use performance insights to drive continuous improvement. Working closely with leadership, operations teams, and healthcare clients, you will help develop effective workflows, educational resources, and specialized clinical programs. This position is ideal for a physician leader who values clinical rigor, collaborative problem-solving, and measurable improvements in healthcare outcomes.
Provide clinical leadership, mentorship, and day-to-day guidance to Physician Advisors while maintaining an active production workload across assigned client accounts.
Serve as a senior clinical subject matter expert for complex, high-priority, and escalated cases involving utilization review, medical necessity determinations, and peer-to-peer (P2P) discussions.
Establish and reinforce consistent standards for clinical decision-making, documentation, communication, and client service.
Conduct and oversee regular quality reviews and call audits to assess clinical accuracy, communication effectiveness, compliance with standards, and overall performance.
Monitor key performance indicators, including P2P completion rates, callback responsiveness, overturn rates, quality, timeliness, and client satisfaction.
Analyze performance trends and identify opportunities for targeted coaching, physician education, workflow optimization, and quality improvement.
Collaborate with Human Resources and Operations on performance reporting, physician development, accountability, and improvement initiatives.
Support onboarding, training, and continuing professional development for Physician Advisors.
Develop and maintain educational resources, reference materials, and standardized best practices for P2P preparation, documentation, escalation, follow-up, and payer communication.
Act as a senior clinical point of contact for clients, providing guidance on escalated clinical and operational issues and participating in client meetings, operational reviews, and clinical discussions.
Identify trends in denials, medical necessity decisions, payer behavior, and utilization management practices that may affect client outcomes.
Partner with organizational leadership to develop clinical recommendations, improve operational workflows, and expand Physician Advisor services, subject matter expertise offerings, and specialized clinical programs.
Contribute to the continued development, standardization, and effectiveness of the Physician Advisor program while balancing leadership responsibilities with production, quality, and service expectations.
Medical licensure: An active, unrestricted physician license in the United States.
Board certification: Board certification in an appropriate medical specialty.
Physician Advisor expertise: Significant experience as a Physician Advisor, including the ability to maintain an active clinical production workload while supporting team leadership and quality oversight.
Clinical and operational knowledge: A strong background in utilization management, hospital medicine, healthcare revenue cycle management, or a related clinical setting.
Utilization management proficiency: Demonstrated expertise in peer-to-peer reviews, medical necessity determinations, inpatient admission criteria, continued stay reviews, denials, appeals, and payer processes.
Complex case management: Experience evaluating challenging clinical cases, interpreting medical necessity requirements, and conducting effective payer-to-provider discussions and negotiations.
Leadership and mentorship: Experience coaching, mentoring, or leading physicians is preferred, with the ability to support professional development and reinforce consistent performance standards.
Quality improvement: The ability to evaluate performance metrics, conduct quality audits, identify trends, and translate findings into actionable improvement initiatives.
Communication and collaboration: Strong written and verbal communication, negotiation, interpersonal, and problem-solving skills, with the ability to work effectively with physicians, operational teams, organizational leadership, and healthcare clients.
Technology proficiency: Familiarity with Epic or other major electronic health record (EHR) platforms is preferred.
Remote work capability: The ability to work independently in a remote, client-facing environment while meeting clinical production, leadership, quality, timeliness, and service expectations.
Adaptability: Strong organizational skills, sound clinical judgment, and the ability to manage competing priorities while maintaining high professional standards.
Travel: Willingness to travel as needed.
Remote work: The position is listed as remote, offering the flexibility to work outside a traditional on-site office environment.
Employment type: Full-time position.
Clinical leadership opportunity: The opportunity to lead and mentor Physician Advisors while maintaining direct involvement in clinical work.
Professional impact: The ability to improve utilization management practices, medical necessity decisions, denial prevention, and healthcare client outcomes.
Program development: The opportunity to shape clinical standards, physician education, quality initiatives, and the continued growth of specialized Physician Advisor services.
Compensation and additional benefits: Salary, bonuses, healthcare coverage, retirement plans, paid time off, and other benefits were not specified in the available job description and should be confirmed with the hiring team.
Travel expectations: Some travel may be required based on business and client needs.
