Physician Advisor – Part Time, 1099, CA License Required

Alignment Health

Physician Advisor optimizing care for seniors working collaboratively in the healthcare system. Utilize effective methods for medical necessity reviews and quality care management in a remote setting.

Posted 7/24/2026part-timeRemote • California • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical care, quality management, and utilization review, with a strong focus on compliance with Medicare/CMS guidelines. Proven ability to lead interdisciplinary teams and develop effective case management protocols.

Highest-signal resume keywords

Clinical CareUtilization ReviewQuality ManagementLeadershipCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medicare ComplianceCMS GuidelinesCase ManagementClinical OversightHEDIS ProjectsSTARS ProjectsMedical Quality CommitteeChronic Disease ManagementClaim Denial ProcessResearch Methodology

Soft Skills

Positive CommunicationCollaborationTeachingProfessionalismRelationship Building

Certifications & Qualifications

Medical DegreeSpecialty Residency

Industry Keywords

Healthcare Delivery SystemsHealthcare Financial IssuesMedical Staff GovernanceQuality OutcomesInterdisciplinary Team

About the role

Key responsibilities & impact

Processes second level reviews in compliance with Medicare/CMS: NCD, LCD and Milliman guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care and Pharmacy.
Provides appropriate level of care classifications as well as continued stay reviews in compliance with CMS and Milliman guidelines.
Acts as a liaison between the medical staff, utilization review and 3rd party payers to effectively promote the appropriate levels of medical care.
Reviews the entire claim denial process, including Appeals and Grievances.
Serves as a Physician member of the utilization review team.
Works with Interdisciplinary Team to develop case management protocols and provide oversight for NP’s/PA’s training.
Acts as a Clinical Leader for HEDIS and STARS projects and serves as Clinical Advisor for HCC and RAF.
Serves as a Chairperson for Medical Quality Committee and provide Clinical Oversight for Chronic Disease Management programs and Quality Outcome.
Collaborates closely and provide assistance to Quality Director.
Works with Extensivists and Middle Level Practitioners (NP’s/PA’s) to reduce length of institutional stay, all cause readmission reduction and ER overutilization ensuring patients and therapeutic modalities.
Assists the organization to challenge physician practices in order to achieve the organization's clinical outcomes and quality goals.

Requirements

What you’ll need

Minimum of 3 years of experience in hospital-wide or skilled nursing facility position involving clinical care, quality management, utilization and case management, or medical staff governance required.
Completion of medical school and specialty residency (preferably in internal medicine) required.
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Knowledge of current medical literature, research methodology, healthcare delivery systems, healthcare financial/reimbursement issues, and medical staff organizations.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.

Benefits

Comp & perks

Health insurance
401(k) matching
Flexible work hours
Paid time off
Remote work options