Physician Advisor

Job description: Job Title: Physician Advisor (Utilization Review & Clinical Denials) - Physicians and Doctors only Location: On-site, Guadalajara, Jalisco, Mexico Job Type: Full-time Salary: $23,000 MXN gross per month (Approx. $19,120 MXN net after statutory deductions) Benefits: Competitive remuneration, annual performance-based bonus, standard industry benefits. Shift Schedule: Training Period: Monday to Friday, 7:00 AM - 4:30 PM Post-Training: Schedule may transition to Tuesday to Saturday, 7:00 AM - 4:30 PM Who You Are: You are a licensed Physician (Cédula Profesional) looking to apply your clinical expertise in a dynamic, office-based environment. You have a sharp analytical mind, impeccable integrity, and advanced English skills. This role is perfect for a doctor who enjoys the analytical side of medicine, thrives on detail-oriented work, and wants to play a critical role in the healthcare ecosystem without being in direct patient care. About the Role: We are seeking a dedicated Physician to join our Utilization Review team. In this pivotal role, you will be the key medical authority ensuring that patient care is medically necessary, appropriately documented, and aligns with reimbursement policies. You will use your clinical knowledge to review cases, guide treating physicians on documentation, and help navigate the complexities of insurance claims and denials. This position is crucial for advocating for patients and ensuring the financial viability of care. Key Responsibilities: Conduct comprehensive Utilization Review (UR) for patient admissions, services, and length of stay, assessing for medical necessity against established criteria. Perform concurrent chart reviews to ensure clinical documentation supports the level of care provided. Act as a clinical liaison between treating physicians and the health plan, facilitating discussions on patient care and documentation requirements. Analyze and appeal clinical denials from insurance payers by writing robust medical necessity letters and compiling supporting evidence from medical records. Identify gaps in clinical documentation and consult directly with attending physicians to ensure completeness and accuracy. Meticulously document all actions and outcomes in the electronic medical record (EMR) system. Participate in peer review meetings and contribute to projects aimed at improving care quality and efficiency. What We're Looking For (Requirements): Must possess a valid Mexican medical license (Cédula Profesional de Médico Cirujano). Medical Degree (Doctorate in Medicine) from an accredited institution. Advanced English proficiency (both written and spoken) is mandatory for reviewing complex charts and communicating with international stakeholders. Recent graduates are encouraged to apply; this is an excellent opportunity to start your career. Unflinching personal and professional integrity. Exceptional attention to detail and analytical, problem-solving skills. Strong time management and the ability to multitask effectively in a fast-paced environment. Excellent communication skills and a collaborative team spirit. Why Apply? Launch a Unique Career Path: Use your medical degree in a growing, in-demand field (Utilization Management/Clinical Denials). Stable Day Schedule: Enjoy a structured schedule with consistent hours. Valuable Training: No prior experience in UR is required; we provide comprehensive training. Professional Environment: Work in a corporate setting that values your clinical expertise.

Creado: Jue, 01 de Ene de 1970