Internist Sound Physicians in California

The successful physician advisor has a strong clinical background, an investigative nature, excellent written English communication skills, and EMR competence. Our advisors must write well-informed, clinically supported case reviews that can be clearly understood by case managers, bedside providers, and ultimately, payers. Understanding Medicare regulations and commercial payer guidelines and applying those concepts during case reviews are essential in this role

• Our physician advisors operate across multiple states, including Arizona, California, Florida, Kentucky, Nevada, and West Virginia, collaborating with partner hospitals to improve services and outcomes.

• MD or DO Licensure within the state of employment.
• Board Certification (base specialty) Internal Medicine, Emergency Medicine, Critical Care recognized by ABMS or ABQAURP.
• Utilization-specific training from ABQAURP (The American Board of Quality Assurance and Utilization Review Physicians), or equivalent within 12 months of hire.
• Education on application of medical necessity criteria within 3 months of hire.
• 3 years post-residency experience as an advisor - strongly preferred.
• Authorized to work in the United States.

• Flex advisor who completes 10 Level of Care (LOC) shifts per month from 8:00 AM to 6:00 PM EST, and 80 Peer-to-Peers per month.
• Level of Care Determinations (LOC) for 6:00 AM to 2:00 PM ET, Monday-Friday, 20 shifts per month.
• Peer-to-Peer reviews: 8:00 AM to 5:00 PM EST, Monday-Friday, 140 Peer-to-Peers per month.

• Holistic Case Review: Direct review of the medical record is provided by licensed physicians, leading to all-inclusive determinations encompassing medical necessity, accuracy of documentation, and clinical documentation improvement, ensuring regulatory compliance and reinforcing best practices for care coordination.
• Level of Care (LOC) determinations.
• Peer-to-Peer reviews.

• Health Benefits, 401k, CME.
• Productivity based (per case rate).