Part-time Associate Physician Advisor - Utilization Review

Job description

Description Physician Advisor (Utilization Review): Part-Time | Remote (U.S. Based): Medical Review Institute of America (MRIoA) is a nationally recognized leader in utilization management and clinical review services, delivering evidence-based solutions for more than 43 years . We are currently seeking a part-time Physician Advisor to join our growing, fully remote team. POSITION OVERVIEW: In this role, you will apply your clinical expertise to evaluate requests for medical services, interpret benefit language and medical policies, and make sound coverage determinations. You may also engage in peer-to-peer discussions with treating providers. This position emphasizes independent clinical judgment, thorough documentation, and collaboration with a nationwide team of Medical Directors. Core Responsibilities: - Perform clinical coverage reviews using member benefits, medical policies, and established clinical guidelines - Interpret benefit language to support accurate and compliant determinations - Document review outcomes in alignment with regulatory, accreditation, and internal standards - Participate in peer-to-peer discussions with treating providers as needed - Collaboration with...