MHMDAA Physician Strike Team — Clinical Advocacy Reviewing Physician

Transforming P2P Into a High-Velocity Clinical Intervention

The primary purpose of the MHMDAA Physician Strike Team / Clinical Advocacy Reviewing Physician role is to transform the Peer-to-Peer (P2P) process from a passive administrative task into a High-Velocity Clinical Intervention. By involving a specialized physician early in the process to address payer denials — such as patient status, surgical authorizations, or site-of-service — this role ensures specialty parity with payer medical directors and shifts the burden of proof back to the payer.

This proactive approach is designed to significantly reduce “Observation-by-Default” determinations and increase the likelihood of admission status request approvals, aiming to raise the average approval rate from 22% to 68%.

Who We're Looking For

We are seeking a board-certified physician to join the MHMDAA Physician Strike Team. In this role, you will provide High-Velocity Clinical Intervention by conducting Accelerated Peer-to-Peer (P2P) consultations to address and overturn payer denials regarding patient status (Inpatient vs. Observation), surgical authorizations, and site-of-service. By intervening early and ensuring specialty parity with payer medical directors, this role aims to significantly increase admission status request approval rates.

Key Responsibilities

1. Rapid Response & Case Initiation — Monitor the MHMDAA mobile interface for automated targeted broadcasts for cases matching your specialty during a designated 3–6 hour window. Upon accepting a case, initiate work within a 4-hour window.
2. Forensic Clinical Review — Perform a 30-minute forensic deep-dive review of the patient's electronic health record via a secure link — reviewing admitting physician's status determination, physiological indicators, diagnostic testing, and medical necessity.
3. Clinical Collaboration — Contact the treating physician with clarifying questions regarding the patient's status and treatment. Collaborate with an MHMDAA Clinical Lead (RN/Tech) who will provide relevant Evidence-Based Care Criteria (Milliman, InterQual, or Specialty Guidelines) mapped to the case.
4. Peer-to-Peer Adjudication — Conduct a mandatory 15-minute P2P conversation with the Payer Medical Director on a recorded line. Advocate for the patient by communicating acute risks, validating clinical presentations against national guidelines, and challenging payer denials under CMS 42 CFR § 412.3 (Two-Midnight Rule).
5. Dispute Resolution — If a final determination cannot be reached during the call, propose a defined Follow-up Window (e.g., 4 hours) to reevaluate the patient based on pending diagnostic results or treatments.
6. Documentation & Legal Certification — Draft a comprehensive Clinical Advocacy Note capturing clinical indicators, P2P discussion points, and final disposition. This note serves as the legal “Black Box” and acts as primary evidence for Federal IDR or ERISA appeals under the No Surprises Act or State Prompt Pay laws.
7. Administrative Integration — Push the completed Clinical Advocacy Note into the Hospital's Utilization Management record via HL7/FHIR interface or secure PDF. Track time to the nearest 0.1 hours by category: (a) Record Review, (b) P2P Conversation, (c) Documentation.

To apply, mail to info@mhmdaa.com

• Active Board Certification in a specific medical specialty (e.g., General Medicine, Surgery, Pediatrics, Cardiology, Orthopedics, or Hospitalist) to ensure specialty parity with payer reviewers
• Availability to mark yourself “Active” and “Available” for specific 3–6 hour time windows
• Strong working knowledge of Evidence-Based Care Criteria (Milliman, InterQual, etc.) and national coverage standards
• Excellent communication and negotiation skills to effectively challenge payer logic and articulate acute clinical risks (e.g., hemodynamic instability, post-surgical complications)