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Physician Advisor (MD OR DO) *MUST BE LICENSED IN FL, NC OR TX)
Position Summary: The Physician Advisor works with Health Plan Medical Director, Utilization Management team, Appeals and Grievances team and Claims department to ensure medically necessary use of services, manage total cost of care and ensure that benefits are administered appropriately. Through remote access to our web-based Portal, Physician Advisor will complete clinical reviews for medical necessity, maintain compliance, adjudicate appeals and grievances from members and providers. General Duties/Responsibilities (May include but are not limited to): Perform utilization reviews in compliance with Medicare NCD & LCD, Milliman guidelines, evidence based guidelines and health plan guidelines. Render medical necessity coverage determination for prior


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