Remote Physician Advisor, Utilization & Medical Policy
BlueCross and BlueShield of South Carolina
- Remote job
BlueCross BlueShield of South Carolina is seeking a Physician Advisor to optimize resource use, assess medical necessity, and support documentation and compliance across care settings. This full-time remote role engages with a multidisciplinary team to ensure appropriate levels of care and adherence to policies. You will perform utilization management reviews, stay current with CMS/MCG guidelines, and serve as a medical resource for quality improvement. #J-18808-Ljbffr BlueCross and BlueShield of South Carolina
- ...Physician Advisor The Physician Advisor provides physician... ...appropriate resource utilization. Key... ...physician reviews for medical necessity, level of care... ...regulations, and payer policies Support compliance... ...teams Experience in a remote or consulting healthcare...Remote workPolicyMedical
- ...Position Purpose: The Physician Advisor optimizes efficient management... ...and determination of medical necessity in case evaluation and utilization management. The... ...hours/week) Monday-Friday REMOTE in the United States.... ...and payor partner policies. * Uses, protects and...Remote workPolicyMedicalFull timeFor contractorsLocal areaMonday to Friday
$198k - $297k
...hospitals and affiliated physician groups. They offer... ...The Physician Advisor provides... ...managing resource and utilization to deliver quality... ...closely with the medical staff leadership,... ...scale. - This is a remote position; however,... ...employer. It is our policy not to discriminate...Remote workPolicyMedicalTemporary workWork at officeLocal area- ...healthcare organization is seeking a RCS-Physician Advisor to join their Denial Management team. This full-time remote position requires a medical degree and board certification, along... ...hospital services and resource utilization. #J-18808-Ljbffr Indiana University HealthRemote jobMedicalFull time
- Downstate is seeking a Physician Advisor to optimize healthcare delivery by guiding medical necessity decisions, utilization management, and quality initiatives. In this full-time role... ...alignment, and outcomes. You will lead policy development, oversee the Utilization...PolicyMedicalFull time
- ...Physician Advisor Peer-to-Peer (P2P) Medical Reviewer Location: Fully Remote | Candidates must be available to work Eastern Time (EST... ...treating providers regarding utilization management determinations.... ...necessity criteria, health plan policies, and clinical judgment to...Remote workPolicyMedicalPart timeImmediate startNight shift
- ...Place to Work" company is seeking a Physician to provide utilization review services for the Group Health... ...utilizing clinical expertise to review medical records and provide an... ...based guidelines, and client-specific policies. Dane Street's success relies...Remote workPolicyMedical
- ...you a Board Certified Medical Doctor (Family Medicine... ...for a full-time, remote job in a nonclinical setting... ...is seeking a physician board-certified in either... ...team full-time as a Utilization Management Physician Reviewer... ...to follow all company policies and procedures in...Remote workPolicyMedicalFull timeMonday to FridayWeekend work
- ...Vivo HealthStaff is recruiting for a Utilization Review Physician based in New York for a Managed Care... ...Responsible for the administration of medical services for company health plan utilizing the evidence-based medical policies and clinical guidelines of the plan, to...Remote workPolicyMedical
$248.5k - $373k
...$373,000.00/yearJob Area: Medical & Clinical OperationsCompany... ...or family medicine physician to join our Utilization Management team. Optum is... ...enjoy the flexibility to work remotely * from anywhere within the... ...medicine guidelines, and UM policies and procedures with counsel...Remote workPolicyMedicalMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home- Oscar Health seeks a Physician Reviewer to join the Utilization Management team in a remote US-based role. You will determine the medical appropriateness of services and document decisions... ...and adherence to laws and internal policies. The role offers strong benefits and...Remote jobPolicyMedical
$230k
...Utilization Management Physician Reviewer We're building a world of health around... ...Health Location: Fully Remote Hours: Full-Time, Monday... ...clinical judgment, and internal policies and procedures. Regardless... ...responsible for ensuring medically appropriate care is...Remote workPolicyMedicalFull timeMonday to Friday$160k - $300k
...00 - $300,000/yearJob Area: Medical & Clinical OperationsCompany... .... Growing together. In this Physician Advisor role, you will partner with... ...enjoy the flexibility to work remotely * from anywhere within the U... ...standards and CMS policy regarding inpatient admissions...Remote workPolicyMedicalMinimum wageFull timeWork experience placementLocal areaAll shiftsFlexible hoursWeekend workAfternoon shift$219k - $286.9k
...Remote Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance... ...role You will determine the medical appropriateness of inpatient... ...internal guidelines and policies, while utilizing clinical acumen...Remote workPolicyMedicalFull timeFor contractorsLocal areaWork from homeRelocationHome officeWeekend work- In this remote contract role, the physician reviews clinical service requests from members... ...to physician review policies, procedures, and continuous... ...as assigned by the Medical Director. Use computer-based... ...Preferred Experience in utilization review, case review, or related...Remote workPolicyMedicalFull timeContract workWeekend workWeekday work
$213.1k - $308.3k
...primary care, care for the most medically and socially complex... ...communities we serve. The Job The Utilization Management (UM) Physician Medical Director provides... ...to program strategy, policy development, quality... ...per year Work Mode - Mostly Remote: Employees who reside outside...Remote workPolicyMedicalFor contractorsWork at officeLocal areaRelocation- ...Back to jobs Physician Advisor – (P2P) Medical Reviewer (1099 Contractor) Remote - USA Apply Position Summary The Physician Advisor... ...treating providers regarding utilization management determinations. The... ...criteria, health plan policies, and clinical judgment to determine...Remote workPolicyMedicalFull timeFor contractorsNight shift
$250k
...Summary The Care Management & Utilization Management Physician Advisor is a physician leader who... ...liaison among the medical staff, Patient Care Services... ...and revision of policies and processes related to... ...responsibilities may be performed remotely as appropriate. May require...Remote workPolicyMedicalLive inWork at officeShift work- General Summary:The System Physician Advisor for CDI serves as a key liaison... ...Structure:• Direct: Chief Utilization Officer• Dotted Line: Chief... ...Integrity· Review inpatient medical records for accuracy, completeness... ...compliance.· Contribute to policy development and CDI program...PolicyMedical
$93.6k - $312k
...Sentara Health.As a Regional Physician Advisor, you'll leverage your... ...the Clinical Revenue Cycle’s Utilization Review and Denials/Appeals processes... ...with hospital and medical staff leadership, facilitating... ...positions that are available as remote work,Sentara Health employs...Remote workMedicalFull timeTemporary workShift work$93.6k - $312k
...VAWork ShiftFirst (Days)Overview:Physician Advisor - Sentara Virginia Beach... ...timely and compliant medical necessity reviews and assists... ...support of Sentara's centralized Utilization Review (UR) process.The Physician... ...that are available as remote work,Sentara Health employs...Remote workMedicalFull timeTemporary workShift work- ...year in a row.HealthPark Medical Center and Lee... ...(EHR) experience for physicians and providers. The award... ...is seeking a Physician Advisor!Lee Health is a nonprofit... ...patient results and payor policies. A dynamic individual... ...and optimize resource utilization through...PolicyMedicalWork at officeRelocationMonday to FridayWeekend work
- ...Health is Seeking Full-Time Physician Advisors Throughout New Jersey!... ...corporate administration, the medical staff, and the case management... ...program that includes utilization management, progression of... ...of medical guidelines and policies geared toward quality and efficiency...PolicyMedicalFull timeTemporary workLocal area
- ...Health is Seeking Full-Time Physician Advisors Throughout New Jersey!... ...corporate administration, the medical staff, and the case management... ...program that includes utilization management, progression of... ...of medical guidelines and policies geared toward quality and efficiency...PolicyMedicalFull timeTemporary workLocal area
- The Physician Advisor is a key member of the healthcare organization’s leadership... ...the effective, efficient utilization of health care services.... ...-utilization of resources, medical necessity, levels of care,... ...standards and policies.Strong computer skills and...PolicyMedicalContract work
- ...Health is Seeking Full-Time Physician Advisors Throughout New Jersey!... ...corporate administration, the medical staff, and the case management... ...program that includes utilization management, progression of... ...of medical guidelines and policies geared toward quality and efficiency...PolicyMedicalFull timeTemporary workLocal area
$300k - $350k
...hospice and a network of physician practices across the... ...care and utilize evidence based practice... ...improvement (CDI). Policy-Setting Responsibilities... ...alignment with the Physician Advisor’s assigned facility, as... ...improvement. Interacts with medical staff by seeking...PolicyMedical- ...market access expertise, medical communications,... ...seeking a Principal Advisor, Patient Services Marketing... ...affordability, and appropriate utilization. Advise clients on... ...market access shifts, policy changes, and... ...combining in-office and remote work to facilitate collaboration...Remote workPolicyMedicalFull timeTemporary workSummer workWork at officeFlexible hoursShift work
- ...time Human Performance Advisor (HPA) to join our team... ..., and programmatic and policy recommendationsSecure,... ...human performance services utilizing a demonstrably... ...meetings with POTFF staff, medical staff, and chain of commandUtilize... ...60% in-office and 40% remote, with Monday and...Remote workPolicyMedicalFull timeWork experience placementWork at officeLocal areaFlexible hours
- ...Our partner is looking for a Physician Advisor Lead based in the United States... ...operational excellence in a remote healthcare environment. You... ...workload and supporting complex utilization management cases. The role focuses on improving medical necessity determinations,...Remote workMedicalFull timeWork at office
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