ABOUT UM PHYSICIAN ADVISORS

Physician-led expertise for complex utilization-management decisions.

UM Physician Advisors LLC provides physician-level utilization-management and advisory services for healthcare organizations. Our work brings together clinical medicine, coverage requirements, evidence, healthcare operations, and clear patient-specific reasoning.

OUR OPERATING PRINCIPLECriteria guide the review process. Clinical evidence informs the analysis. Physicians make the patient-specific determination.

WHY WE EXIST

Utilization management is clinical work.

Medical necessity sits at the intersection of medicine, coverage requirements, healthcare operations, and responsible resource use. Effective physician review requires more than a diagnosis lookup or checklist. It requires reconstruction of the clinical course, application of the governing framework, and clear physician reasoning.

Our model is designed for healthcare organizations that need physician-level review capacity for complex, ambiguous, disputed, or evolving clinical questions.

Leadership

Pankaj Karan, M.D., ABIM, Founder and Medical Director of UM Physician Advisors LLC

Leadership philosophy

Clinical criteria are decision-support tools. High-quality utilization management also requires patient-specific physician judgment, consistent documentation, and careful application of the payer and regulatory framework governing the case.

FOUNDER & MEDICAL DIRECTOR

Pankaj Karan, M.D., ABIM

Board-certified internal medicine physician with 30+ years of clinical medicine experience and 25+ years of utilization management experience.

Experience across health plans/HMOs, hospitals, and medical groups
Utilization-management work since 2000
Focused expertise in outpatient/observation vs. inpatient status review

Dr. Pankaj Karan is an ABIM board-certified internal medicine physician with more than 30 years of clinical experience and more than 25 years of utilization management experience. Since 2000, his utilization-management work has spanned health plans, hospitals, and medical groups, providing a broad perspective on medical necessity, patient status, coverage requirements, and healthcare operations.

His experience includes physician-review and medical-director work within major managed-care organizations, including UnitedHealthcare/Optum and Alignment Health, as well as hospital and medical-group utilization management. His review work includes prior authorization, outpatient/observation versus inpatient status review, concurrent and continued-stay review, retrospective medical-necessity review, appeals and provider disputes, peer-to-peer review, post-acute care, and complex-case escalation.

He leads UM Physician Advisors with a physician-first approach: define the clinical question, identify the governing coverage framework, evaluate the complete clinical record and trajectory, apply authorized criteria and relevant evidence appropriately, and document a clear, patient-specific physician rationale.

Simran Kahai, Ph.D.

Vice President, Business Development

Dr. Simran Kahai is an economist, educator, and global business strategist with extensive experience in international business, entrepreneurship, economic analysis, and organizational development. She is an Associate Professor of Economics and Finance at John Carroll University, where she holds the Endowed Professorship in International Business and Finance and serves as founding director of the Global Business Culture and Entrepreneurship Program. She has developed international academic and entrepreneurship programs across multiple countries and has served on the boards of several institutions. As Vice President of Business Development at UM Physician Advisors LLC, Dr. Kahai leads strategic growth initiatives, partnerships, market development, and organizational expansion.

Advisory Board

Neeti Dewan, CPA

Advisory Board Member

Neeti Dewan is a finance executive, entrepreneur, board advisor, and CEO of Platinum AdvantEdge. Her career spans Fortune 500 companies, Big Four accounting, strategic finance, taxation, governance, and entrepreneurship. She brings UMPA expertise in financial strategy, organizational growth, corporate governance, leadership, and scalable business operations.

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Advisory Board members provide strategic guidance to UM Physician Advisors LLC and do not participate in individual utilization-management determinations unless separately credentialed and authorized for that function.

HOW WE WORK

Clinical rigor with a disciplined review process.

The operating model is designed to preserve independent physician judgment while producing determinations healthcare organizations can use.

Independent Physician Judgment

Patient-specific clinical reasoning remains central when the record, criteria, and governing requirements must be reconciled.

Framework-Aware Review

Review begins by identifying the payer, benefit, coverage policy, Medicare requirement, or other framework that governs the question.

Complete Clinical Record

Presentation, severity, treatment, response, complications, function, and clinical trajectory are evaluated together.

Clear, Defensible Rationale

The determination connects the material clinical facts to the governing framework with concise physician reasoning.

WHO WE SUPPORT

Physician-review capacity across healthcare organizations.

PAYERS

Health Plans & Managed Care

Medical necessity, level of care, appeals, retrospective, peer-to-peer, and post-acute review support.

DELEGATED UM

Medical Groups & IPAs

Physician-level review supporting delegated utilization management and medical-director workflows.

PROVIDERS

Hospitals & Health Systems

Physician-advisor support for patient status, continued stay, retrospective analysis, and complex UM workflows.

PARTNERS

UM & Healthcare Organizations

Flexible physician-review capacity for specialized, high-volume, overflow, or customized programs.

CORE AREAS OF PHYSICIAN REVIEW

Physician-level support across the utilization-management continuum.

Medical Necessity & Level of Care

Admission/status, continued stay, retrospective review, and complex medical-necessity analysis.

Appeals & Peer-to-Peer

Independent reconsideration, physician-to-physician discussion, and clear clinical rationale.

Post-Acute Review

IRF, SNF, LTACH, NOMNC, rehabilitation, and transition-of-care questions.

Specialty & Evidence-Based Review

Coverage-aware review incorporating specialty guidance, regulatory labeling, and evidence when applicable.

UM PHYSICIAN ADVISORS

Clinical judgment at the point where medicine, coverage requirements, and healthcare operations intersect.

Independent clinical reasoning. Clear determinations. Flexible physician-review support.

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