Payer Peer to Peer Physician Advisor

R1rcm is hiring a Payer Peer to Peer Physician Advisor for our remote team serving healthcare organizations across the USA. In this full-time position, you'll provide critical physician-to-physician clinical consultations and peer review services that directly influence patient care decisions and payer operations nationwide.

What This Role Involves

As a Payer Peer to Peer Physician Advisor for R1rcm, you'll serve as a trusted clinical voice in the peer review and utilization management process. You'll conduct consultations with treating physicians, evaluate medical documentation, and deliver evidence-based clinical opinions on medical necessity determinations. Working entirely remote, you'll engage with physicians across the country, requiring strong clinical expertise, exceptional communication skills, and the ability to navigate complex healthcare scenarios with professionalism and judgment. Your work directly supports both provider organizations and payers in ensuring clinical decisions are appropriate, efficient, and evidence-based.

Core Duties

• Conduct peer-to-peer consultations with treating physicians regarding clinical determinations and care recommendations
• Review medical records and clinical documentation to assess medical necessity and appropriateness of treatment
• Engage in physician-to-physician consultations on complex cases, treatment protocols, and clinical questions
• Document peer review interactions thoroughly and accurately in compliance with regulatory and company standards
• Communicate clinical findings and recommendations to internal teams and external healthcare stakeholders
• Maintain knowledge of current clinical guidelines, evidence-based medicine, and payer policy requirements

Qualifications

• Active state medical license (MD, DO, or equivalent) in the United States
• Clinical experience and strong medical knowledge applicable to peer review and utilization management
• Demonstrated ability to communicate effectively with physicians in professional peer discussions
• Experience with medical record review, clinical assessment, and healthcare documentation practices
• Capacity to work independently and manage time effectively in a remote work environment
• Knowledge of healthcare regulations, utilization management, or peer review processes is preferred

Why Join R1rcm

R1rcm is a leader in healthcare solutions, and our physician advisor team contributes to meaningful work that influences patient care and healthcare quality. You'll work with a supportive, collaborative remote team while maintaining the clinical autonomy and professional respect physicians deserve. This role offers the opportunity to apply your medical expertise in a modern, flexible setting while supporting the broader healthcare ecosystem and improving clinical outcomes across the nation.

Ready to Apply?

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.