Physician Advisor- Peer-to-Peer Medical Reviewer

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Physician Advisor- Peer-to-Peer Medical Reviewer based in United States.

As a Physician Advisor – Peer-to-Peer Medical Reviewer, you will conduct clinical discussions with treating providers regarding utilization management determinations and requested services. You will review clinical documentation, assess medical necessity, and determine appropriate levels of care using evidence-based criteria and applicable regulatory requirements. The role involves direct physician-to-physician communication and requires sound clinical judgment when evaluating complex or disputed cases. You will apply Medicare Advantage and CMS requirements alongside established utilization management guidelines and health plan policies. You will also contribute to timely, consistent, and compliant case decisions while identifying opportunities for provider education and process improvement. This full-time remote opportunity is designed for an experienced physician comfortable working collaboratively across clinical and utilization management environments.