Physician Advisor – Remote (Utilization Management & Clinical Operations)
Requisition ID: 2265075
Job Category: Medical & Clinical Operations
Primary Location: Newtown Square, Pennsylvania, United States
Work Mode: Remote (U.S.-based candidates only)
Employment Type: Full-Time
Shift Coverage: Evening/Night (6:00 PM – 3:00 AM EST)
About the Organization
Optum, part of UnitedHealth Group, is a global healthcare services and technology organization committed to improving health outcomes for millions worldwide. By integrating clinical expertise, data analytics, pharmacy benefits, and care delivery solutions, Optum supports a more connected, efficient, and equitable healthcare system.
At Optum, professionals work in a culture driven by diversity, inclusion, innovation, and clinical excellence, with access to robust career development opportunities and comprehensive benefits.
Position Overview
The Physician Advisor plays a critical role in hospital utilization management and clinical documentation review, ensuring that inpatient and outpatient care is delivered in a timely, medically appropriate, and cost-effective manner. Working remotely, this role partners closely with hospital case managers, attending physicians, and internal clinical teams to support regulatory compliance, evidence-based care, and optimal length of stay management.
This position requires strong clinical judgment, effective communication skills, and the ability to collaborate across multidisciplinary teams in a fast-paced, virtual environment.
Work Schedule
Core coverage: Monday–Friday, 6:00 PM – 3:00 AM EST
One Monday off per four-week cycle, replaced by Saturday or Sunday evening coverage
Shared responsibility for weekend and holiday coverage among all Physician Advisors
Fixed schedules assigned based on business needs to ensure adequate staffing
Key Responsibilities
Promote efficient, evidence-based, and cost-effective clinical care for hospitalized patients through utilization review and clinical documentation analysis.
Ensure compliance with CMS regulations, payer policies, and regulatory standards related to inpatient admissions, observation status, and continued stays.
Collaborate with hospital Case Managers and Attending Physicians via telephonic and virtual communication to discuss care plans, clinical appropriateness, and length-of-stay management.
Provide specialized clinical expertise for specific patient populations to support utilization management decisions.
Meet defined performance, productivity, and quality benchmarks while maintaining high standards of customer service.
Function as an integral member of a multidisciplinary team including Physician Advisors, nurses, administrative staff, and clinical leadership.
Complete administrative duties, mandatory training, and ongoing education related to regulatory updates, internal policies, and clinical best practices.
Demonstrate professional engagement, accountability, and commitment to organizational and client objectives.
Required Qualifications & Experience
Education:
MD or DO from an accredited medical school.
Licensure:
Current, unrestricted medical license in the state of residence (U.S.).
Experience Required:
Minimum 3 years of hospital-based clinical practice experience preferred.
Demonstrated experience working with utilization review, case management, or clinical documentation review.
Core Skills:
Strong ability to build rapport with physicians, case managers, and hospital leadership.
Proficiency with Electronic Medical Records (EMRs) and clinical documentation systems.
Ability to work independently in a remote environment during evening and overnight hours.
Excellent clinical reasoning, communication, and documentation skills.
Preferred Qualifications
Board Certified or Board Eligible in a recognized specialty.
Prior experience in Physician Advisor, Medical Director, or Utilization Management roles.
Strong organizational, problem-solving, and decision-making abilities.
Proven ability to collaborate effectively in multidisciplinary and virtual teams.
Demonstrated expertise in regulatory compliance and payer policy interpretation.
Compensation & Benefits
Annual Salary Range: USD $269,500 – $425,500 (Full-Time)
Compensation is based on experience, education, certifications, geographic location, and internal equity.
Eligibility for performance-based bonus incentives.
Comprehensive benefits package, including medical, dental, vision coverage, retirement plans, equity purchase options, and professional development programs.
Equal Opportunity Statement
Optum and UnitedHealth Group are Equal Opportunity Employers committed to fostering an inclusive and diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other legally protected characteristic.
SEO Keywords Optimized
Physician Advisor Jobs USA, Remote Physician Advisor, Utilization Management Physician, Medical Director Remote Jobs, Hospital Utilization Review Physician, CMS Compliance Physician, Optum Physician Careers, UnitedHealth Group Medical Jobs
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