Texas Licensed Physician Advisor

Job Summary

A company is looking for a Physician Advisor to conduct clinical case reviews and ensure effective utilization of health care services.

Key Responsibilities

• Conducts medical record reviews for medical necessity of hospital admissions and quality care management
• Communicates with case management and medical staff regarding medical necessity and appropriate levels of care
• Engages in Peer to Peer discussions with payers as needed

Qualifications

• MD or DO required
• Unrestricted license in Texas required
• Minimum of 5 years of clinical practice required
• Utilization management experience preferred
• In-depth knowledge of CMS regulations and the 2-midnight rule