Delegated Responsibilities
Physician review aligned to the scope of delegated utilization-management functions and the contracting organization's requirements.
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Medical Groups, IPAs & Delegated Organizations
Physician Review Capacity Built for Delegated Utilization Management.
UM Physician Advisors LLC helps medical groups, IPAs, and risk-bearing organizations extend physician-review capacity across complex medical necessity, level-of-care, prior authorization, retrospective, appeal, and post-acute workflows.
Delegated UM supportFlexible physician capacityClient-specific workflowsClear clinical rationale
The operational challenge
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Delegated UM requires both clinical judgment and operational discipline.
Medical groups and IPAs may manage broad clinical populations while balancing physician capacity, turnaround expectations, complex cases, payer requirements, and the need for consistent documentation. We provide physician review where additional clinical depth can strengthen that workflow.
Variable Volume
Flexible capacity for daily workflows, seasonal volume, staffing gaps, backlog reduction, or concentrated projects.
Complex Escalations
Physician-level analysis when routine criteria application does not adequately resolve the clinical question.
Multiple Care Settings
Review support spanning acute hospital, outpatient services, prior authorization, rehabilitation, SNF, and other post-acute needs.
Medical group & IPA capabilities
Physician support across the delegated UM continuum.
Programs can focus on specific review queues or combine multiple review categories within an agreed operational model.
IP
Inpatient & Observation
Physician assessment of hospital level of care, patient-status questions, conversion decisions, and continued acute medical necessity.
See review types →PA
Prior Authorization
Medical necessity review for complex procedures, services, diagnostics, therapies, and other requests within the authorized framework.
See review types →CR
Concurrent & Continued Stay
Review of treatment response, unresolved clinical needs, ongoing intensity of service, and readiness for transition.
See review types →RR
Retrospective Review
Case-specific analysis of completed episodes, including admission, continued stay, medically necessary days, and changes in clinical status.
See review types →AP
Appeals & Provider Disputes
Independent physician reconsideration of prior decisions using the complete submitted record and applicable review framework.
See review types →P2P
Peer-to-Peer Support
Focused physician review and discussion of the clinical facts material to a disputed medical-necessity determination.
See review types →SNF
SNF, NOMNC & Rehabilitation
Assessment of continued skilled needs, functional progress, rehabilitation intensity, discharge readiness, and lower-level alternatives.
See review types →MA
Medicare Advantage Workflows
When applicable, physician review can incorporate relevant Medicare coverage and patient-status requirements within the organization's authorized process.
Explore Medicare Advantage →
A consistent clinical approach
The review follows the patient's clinical course.
Delegated review programs encounter cases where the same diagnosis can support very different determinations. Our physicians focus on what the patient clinically required at the point under review and how that requirement changed over time.
The result is a determination grounded in the record rather than a diagnosis label, utilization category, or isolated criterion.
Criteria guide the review process.Physicians make the clinical determination.
1Clinical RecordReview the documentation relevant to the requested service and dates.
2Clinical TrajectoryEvaluate severity, treatment, response, complications, and continued needs.
3Review FrameworkApply authorized criteria, policies, and coverage requirements when applicable.
4Physician JudgmentIntegrate the clinical facts into an independent case-specific assessment.
5DeterminationApprove, deny, modify, uphold, overturn, or otherwise resolve the assigned question.
6RationaleDocument the material facts and reasoning supporting the determination.
Flexible engagement models
Physician support that can fit the organization you already have.
We can discuss a review model based on delegated scope, case volume, clinical mix, turnaround expectations, escalation pathways, credentialing, licensing, data access, and other operational requirements.
Ongoing Physician Review
Regular physician capacity supporting established delegated UM queues and escalation workflows.
Overflow & Coverage
Additional review capacity during staffing gaps, volume surges, vacations, or temporary operational pressure.
Complex Case Escalation
Experienced physician assessment for cases requiring judgment beyond routine nurse-level or automated review.
Targeted Programs
Defined projects for selected service categories, populations, review types, or workflow improvement initiatives.
Scalable physician capacity.
Clinical judgment integrated into your UM workflow.
Tell us about your delegated responsibilities, review volume, case mix, turnaround expectations, and physician-review needs. We can discuss an engagement model designed around your operation.