Physician Advisor – (P2P) Medical Reviewer (1099 Contractor)

Location: Remote - USA

Base salary range: $240,000–$300,000 USD per year

Company

Health plan organization supporting utilization management and evidence-based medical necessity decisions.

What you will do

• Conduct scheduled and ad hoc peer-to-peer discussions with treating physicians and qualified providers about inpatient, outpatient, post-acute, and other authorization requests.
• Review clinical documentation, utilization management reviews, applicable criteria, and determination rationales before discussions.
• Evaluate medical necessity and level of care, including inpatient versus observation or outpatient status.
• Apply Medicare Advantage, CMS, Two-Midnight, NCD, LCD, MCG, and health plan requirements as appropriate.
• Consider new clinical information and approve or overturn proposed adverse determinations within delegated authority.
• Document discussions, escalate complex cases, identify recurring clinical trends, and collaborate with clinical and operational teams.

Requirements

• MD or DO from an accredited medical school.
• Current, unrestricted U.S. medical license required.
• Board certification in an appropriate clinical specialty; broad medical experience is preferred.
• At least 5 years of clinical practice experience preferred.
• Experience with utilization management, medical necessity review, physician advisory services, payer medical review, or hospital case management strongly preferred.
• Strong physician-to-physician communication skills and the ability to manage difficult or disputed clinical discussions professionally.

Nice to have

• Experience with Medicare Advantage and CMS medical necessity or coverage requirements.
• Familiarity with MCG, InterQual, CMS coverage policies, and the Two-Midnight rule.

Culture & Benefits

• Remote work arrangement for candidates in the USA.
• 1099 contractor engagement.
• Performance expectations include timely P2P completion, documentation quality, decision accuracy, consistency, provider experience, and regulatory compliance.
• Work involves collaboration with nurses, medical directors, appeals and grievances, provider engagement, and other operational teams.