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What is a Physician Advisor?
Physician Advisors provide physician-level medical necessity review and conduct peer-to-peer discussions with treating physicians. They serve as the expert voice in complex medical necessity decisions.
Key Responsibilities
Conduct peer-to-peer calls with requesting physicians
Make second-level medical necessity determinations
Handle appeals and complex cases
Educate physicians on documentation and medical necessity
How It Differs from UM
| Aspect | UM Reviewer | Physician Advisor |
|---|---|---|
| Review type | First-level, criteria-based | Second-level, judgment-based |
| Peer-to-peer | Rarely | Primary function |
| Complexity | Routine cases | Complex/escalated cases |
Compensation Range
Part-time: $150-250 per hour
Full-time Physician Advisor: $250,000 - $350,000
Medical Director: $300,000 - $400,000+
