PAS Physician Advisor - Payer Peer to Peer (Part-Time, Salaried)

About the role

R1 RCM Inc. is looking for a Physician Advisor to work remotely for its client facilities, reviewing payor peer-to-peer cases. The role reviews cases where authorization has been denied, checking whether the proper documentation was available for the requested admission status, procedure and care setting, and advises clients on the appropriateness of the request. It is a part-time, salaried position.

Key responsibilities

• Review denied authorization cases and evaluate whether the documentation supports the requested status, procedure and care setting.
• Advise clients on the appropriateness of requests based on available documentation.
• Discuss cases with medical directors from the payor side.
• Address authorization requests, documentation support or lack thereof, evidence-based criteria and complex clinical evaluations.
• Work during pre-scheduled hours, with schedules set about 30 days in advance.
• Engage with attending physicians to discuss appropriate status supported by documentation.
• Make phone contact with the utilization review team and/or case managers at client hospitals about submitted case determinations.
• Provide written analysis of each case and perform case reviews across multiple specialties.

Required profile

• Active, unrestricted MD or DO medical licensure.
• Minimum 3+ years of clinical experience after residency completion.
• Strong clinical knowledge across multiple clinical areas.
• Able to work independently in a fast-paced, rapidly changing environment.

Required skills

• Proficiency in basic computer skills.
• Ability to meet quality and productivity standards.

What we offer

• Base pay range of $150,075 to $199,070 per year, depending on role, level, location, skills, experience and education.
• Eligibility for an annual bonus plan at a target of 10%.