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Remote Physician Advisor Utilization Review Jobs

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... Physician's office, Hospital/Surgical setting, or Health Care Insurance Company. * Knowledge of ...

CorVel

CA Utilization Review Nurse I

$30.64 - $45.80/hr

This is a remote position. Essential Functions & Responsibilities: * Identifies the necessity of ... physicians and their representatives, as well as advisors/clients and coworkers * Effective ...

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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.

Physician Advisor II - Remote

Med-Metrix

Philadelphia, PA • On-site, Remote

Other

Re-posted 6 days ago

Med-Metrix rating

6.9

Company rating: 6.9 out of 10

Based on 21 frontline employees who took The Breakroom Quiz

283rd of 492 rated business services

Job description

Job Purpose
The Physician Advisor II serves as a leader on the Physician Advisor team, mentoring, teaching internally and externally, maintaining quality across the spectrum of Physician Advisors, and manages PAOC relationships with clients. Additionally, the Physician Advisor II performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. The Physician Advisor II works closely with the Client's medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to recommend methods to optimize use of hospital services for all patients while also ensuring the quality of care. This includes identifying opportunities to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.
Duties and Responsibilities
  • Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management department in a timely fashion
  • Provides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management
  • Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable
  • Maintains accountability for achieving case management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care
  • Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment
  • Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested
  • Meets production standards within established time requirements. Work product and performance meets quality standards
  • Achieve performance goals as outlined in employment agreement
  • Maintains confidentiality of patient care and business matters
  • Demonstrates behavior that supports the organization's mission. Participates in required orientation and training related to the Physician Advisor role
  • Demonstrates commitment to meeting/exceeding strategic initiatives of organization
  • Upholds the organization's values of team work and professionalism and applies Code of Conduct standards to all members of the healthcare team
  • Facilitate, mentor, and educate other physicians regarding payer requirements
  • Attends all meetings as requested by PAOC leadership
  • Participate in the peer review process as may be necessary or requested
  • Maintain medical licensure and board certification in good standing
  • Manages client relationships for PAOC, directing quarterly report creation and JOCs (in concert with the Director of Operations), achieving customer satisfaction and retention
  • Contributes to execution of PAOC's Quality program and continuous PA development
  • Provides education to client facilities' staff on a variety of relevant topics
  • Mentors and trains new Physician Advisors as well as existing Physician Advisors to ensure the highest possible consistency and quality for PAOC determinations
  • Serves as Team Lead for Physician Advisors for Dashboard management as scheduled
  • Fulfills additional duties as needed within the Physician Advisor II role
  • Other duties as assigned
  • Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Understand and comply with Information Security and HIPAA policies and procedures at all times
  • Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications
  • Specialty Board Certified
  • Licensed to practice medicine in the US
  • 3+ years working as a Physician Advisor or UR/UM Medical Director performing case reviews
  • Basic technical skills with Hospital EMRs and Microsoft Office and Teams a must
  • Hold and maintain an unrestricted medical license and Board Certification
  • Possess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety
  • Possess a working knowledge of (Hospital) organization & case management operations and administrative standards and policies
  • Familiarity with MCG/InterQual placement status criteria is preferred
  • Member of the American College of Physician Advisors (ACPA) preferred
  • 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 Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred
  • Proficiency in Microsoft Office Suite
  • Strong interpersonal skills, ability to communicate well at all levels of the organization
  • Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
  • High level of integrity and dependability with a strong sense of urgency and results oriented
  • Excellent written and verbal communication skills required

Working Conditions
  • Monday to Friday for assigned shifts ranging from 8 a.m.-5 p.m. EST to 9 a.m.-6 p.m. EST as assigned by PAOC on a rotating basis; with a holiday coverage requirement of up to 3 holidays per year
  • Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
  • Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
  • Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
  • Work Environment: The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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