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Remote Physician Advisor Utilization Review Jobs

UVA Health

Physician Advisor (Remote)

Manassas, VA · Remote

$250K - $350K/yr

... across Utilization Management (UM), Clinical Documentation Integrity (CDI), Coding, and Case ... Perform medical necessity reviews using MCG and/or InterQual * Support CMS compliance, including ...

HURC Healthcare Solutions

Physician Advisor

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

HURC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

The Resource Group

Physician Advisor

  • Medical

  • PTO

Job Title Ascension in Austin, TX is looking for a PRN (Remote) Physician Advisor to join our team ... Review and offer suggestions related to resources and service management. About the Practice ...

Hurc LLC

Physician Advisor

Short Hills, NJ · Remote

Support utilization review and case management teams with complex clinical decision-making * Ensure ... Experience in a remote or consulting healthcare environment Skills & Competencies * Physician-to ...

Med-Metrix

Physician Advisor - Remote

Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred * Physician Advisor Sub-Specialty Certification by the American Board of ...

Med-Metrix

Physician Advisor - Remote

Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred * Physician Advisor Sub-Specialty Certification by the American Board of ...

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Remote Physician Advisor Utilization Review information

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How much do remote physician advisor utilization review jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for remote physician advisor utilization review in the United States is $24.67, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $26.92 per hour, depending on experience, location, and employer.

What is a remote physician advisor utilization review?

A Remote Physician Advisor Utilization Review is a licensed physician who works remotely to review medical cases and determine if the healthcare services provided are medically necessary and meet insurance or regulatory requirements. They collaborate with clinical and administrative staff, analyze patient records, and provide recommendations on care levels, admissions, and compliance. This role helps healthcare organizations ensure appropriate resource utilization, reduce denials, and maintain quality patient care while working offsite.

What are the key skills and qualifications needed to thrive as a remote physician advisor utilization review?

To thrive as a Remote Physician Advisor Utilization Review, you need a medical degree (MD/DO), active physician licensure, and deep knowledge of clinical guidelines and utilization management. Familiarity with medical necessity criteria (such as InterQual or MCG), electronic health record (EHR) systems, and URAC/NCQA standards is typically required. Excellent communication, analytical thinking, and the ability to work independently are vital soft skills in this position. These competencies ensure accurate medical necessity determinations, regulatory compliance, and effective collaboration with healthcare teams while working remotely.

What are some of the common challenges faced by remote physician advisors in utilization review, and how can they be addressed?

Remote Physician Advisors in Utilization Review often encounter challenges such as interpreting complex clinical documentation, navigating varying payer requirements, and maintaining effective communication with on-site care teams. To address these, it's important to stay updated on payer guidelines, use secure collaboration tools to connect with hospital staff, and participate in ongoing training to enhance clinical review skills. Building strong working relationships with case managers and consistently documenting your recommendations can also help overcome these hurdles and ensure efficient, high-quality reviews.

What is the difference between Remote Physician Advisor Utilization Review vs Remote Medical Director?

AspectRemote Physician Advisor Utilization ReviewRemote Medical Director
Primary RoleReview and approve medical necessity and utilization of healthcare servicesOversee clinical operations, policy development, and provider performance
CredentialsMedical degree, medical license, often board-certified in a specialtyMedical degree, medical license, often with leadership experience
Work EnvironmentRemote, insurance companies, healthcare organizationsRemote or onsite, healthcare organizations, hospitals, insurance companies
Industry UsageCommonly used in utilization management and insurance sectorsUsed in healthcare administration and leadership roles

While both roles require medical credentials and involve healthcare oversight, the Remote Physician Advisor Utilization Review focuses on evaluating medical necessity and utilization, whereas the Remote Medical Director oversees broader clinical operations and policy development. The former is more specialized in utilization review tasks, while the latter involves leadership responsibilities within healthcare organizations.

How do you get into remote physician advisor utilization review?

To become a remote physician advisor in utilization review, candidates typically need a medical degree, valid medical license, and experience in clinical practice or healthcare management. Additional certifications such as Certified Physician Executive (CPE) or Certified Professional in Healthcare Quality (CPHQ) can enhance prospects. Strong knowledge of insurance policies, medical coding, and utilization review processes is essential, along with excellent communication skills for remote work environments.
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Remote Physician Advisor Utilization Review jobs near you
Infographic showing various Remote Physician Advisor Utilization Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 3% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $51,320 per year, or $24.7 per hour.

Remote | Utilization Management & Case Management Clinical Review Consultant $80-$120/hour

24-MAG LLC

Remote

$80 - $120/hr

Other

Re-posted 13 days ago

Job description

Remote | Utilization Management & Case Management Clinical Review Consultant

We are sharing a specialised part-time consulting opportunity for United States-based healthcare professionals experienced in utilization management, case management, medical necessity review, care coordination, discharge planning, clinical review criteria, physician advisor workflows, and healthcare operations leadership.

This role supports current and upcoming remote consulting opportunities focused on AI-assisted healthcare review, utilization management evaluation, case management workflow assessment, clinical documentation review, and high-quality project execution. Selected professionals will apply clinical and operational expertise to evaluate medical necessity determinations, review AI-generated utilization management outputs, assess care coordination workflows, and provide structured feedback based on detailed project criteria.

Key Responsibilities

Professionals in this role may contribute to:

  • Review utilization management and case management workflows involving concurrent review, retrospective review, discharge planning, care coordination, and level-of-care determinations
  • Evaluate AI-generated medical necessity determinations, clinical review outputs, and decision-support recommendations for accuracy and clinical appropriateness
  • Apply InterQual, MCG, Milliman, or similar clinical review criteria to support admission, continued stay, observation status, and inpatient determinations
  • Assess clinical documentation, review logic, and care pathway recommendations against professional utilization management standards
  • Review complex utilization management cases involving peer-to-peer review requests, denial appeals, payer communication, and physician advisor escalation
  • Evaluate workflows related to care transitions, post-acute coordination, discharge planning, and collaboration between clinical teams, payers, and providers
  • Assess operational indicators such as avoidable days, denial rates, observation versus inpatient conversion, readmission risk, and utilization performance
  • Identify gaps, inconsistencies, edge cases, or unsupported conclusions in clinical review and case management outputs
  • Annotate AI-generated healthcare outputs and provide structured feedback to support clinical review quality
  • Explain review decisions with consistency, attention to detail, and professional clinical judgment
  • Apply CMS Conditions of Participation, Two-Midnight Rule, payer-specific requirements, and utilization management best practices where relevant
  • Collaborate through structured project workflows involving clinical, operational, compliance, and healthcare technology review
Ideal Profile

Strong candidates may have:

  • 5+ years of experience in utilization management, case management, clinical review, or healthcare operations
  • At least 2 years of leadership experience in utilization management, case management, physician advisor operations, or related clinical review functions
  • Active clinical licensure, with a Registered Nurse license required for nursing leadership profiles
  • Physician advisor, MD, or DO experience may be especially relevant for physician advisor-focused workflows
  • Strong medical necessity review expertise and deep familiarity with clinical review criteria
  • Exceptional written and verbal English communication skills
  • High attention to detail and ability to critically evaluate clinical documentation, workflow logic, and AI-generated healthcare outputs
  • Ability to work independently in a remote, project-based environment
Educational Background

Active Registered Nurse licensure is required for Registered Nurse utilization management or case management leadership profiles

  • MD or DO background with physician advisor, utilization management, or clinical review experience may be preferred for physician advisor-focused roles
  • Professional experience in health systems, hospitals, payer environments, accountable care organizations, value-based care organizations, or clinical operations teams is highly relevant
  • Backgrounds in utilization management leadership, case management management, clinical documentation review, revenue cycle collaboration, denial management, or care coordination may support project fit
Nice to Have
  • CPUR, ACM, CCM, or similar utilization review, case management, or clinical operations credential
  • Experience managing physician advisor programs, peer-to-peer review processes, denial appeals, or complex medical necessity cases
  • Familiarity with utilization management platforms, clinical review software, EHR systems, or related healthcare operations tools
  • Experience with CMS Two-Midnight Rule, observation status regulations, inpatient criteria, payer policies, and compliance requirements
  • Exposure to healthcare technology, AI-assisted clinical tools, digital health workflows, or structured annotation and review processes
  • Background in health system, accountable care, value-based care, or payer-facing utilization management programs
Why This Opportunity
  • Apply utilization management and case management leadership expertise to structured remote healthcare review work
  • Contribute to high-quality AI-assisted clinical review and medical necessity evaluation workflows
  • Use operational judgment, clinical review criteria, and care coordination experience in a focused evaluation environment
  • Work on flexible assignments aligned with healthcare operations, utilization performance, case review, and clinical decision-support expertise
  • Remote structure with competitive hourly compensation
Contract Details
  • Independent contractor role
  • Fully remote with flexible scheduling
  • United States-based professionals are required for this opportunity
  • Part-time project-based commitment depending on availability, onboarding status, and project needs
  • Competitive rates of $80–$120 per hour depending on clinical background, leadership experience, utilization management expertise, and project scope
  • Weekly payments via Stripe or Wise
  • Projects may be extended, shortened, or adjusted depending on scope and performance
  • Work will not involve access to confidential or proprietary information from any employer, client, or institution

This opportunity is available through 24-MAG LLC. We connect experienced professionals with remote consulting opportunities across technical, evaluation, and project-based workstreams.

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