Interested in This Role?
Send your details to get started. No portal, just email.
About This Role
Job Description
Primary Purpose
We are seeking a Senior Clinical Advocate to join our physician-led team. In this role, you will provide high-level clinical advocacy to hospitals nationwide, working directly with payer medical directors to overturn denials and ensure appropriate patient status determinations.
What You Will Do
- Conduct forensic clinical reviews of patient records and status determinations
- Lead Peer-to-Peer (P2P) consultations with payer medical directors
- Advocate for hospitals by challenging inappropriate denials using evidence-based criteria
- Draft comprehensive Clinical Advocacy Notes for legal and compliance records
- Collaborate with utilization management teams to optimize clinical workflows
Impact
Your work will directly contribute to raising hospital admission approval rates and recovering revenue lost to inappropriate payer denials. This is a role where clinical expertise meets advocacy at scale.
What You Need
Requirements & Qualifications
- Board certification in a medical specialty (Medicine, Surgery, Cardiology, Pediatrics, etc.)
- Minimum 5 years of clinical practice experience
- Strong working knowledge of Milliman, InterQual, and national coverage criteria
- Excellent communication and negotiation skills
- Experience with utilization management or payer relations preferred
- Licensed to practice medicine in at least one U.S. state