Physician Advisor

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide compliant status determinations for patients admitted to the hospital.

• Engage in peer-to-peer reviews with medical directors from payor organizations.

• Conduct daily reviews of short inpatient stays and observation patients.

• Establish relationships with medical staff and leadership to garner support for utilization management initiatives.

• Participate in utilization management committees as a subject matter expert.

• Assist with handling denials and appeals.

• Educate medical staff on various utilization management topics.

• Collaborate with utilization review nurses, insurance authorization personnel, and Case Management to sustain and enhance utilization management processes.

• Monitor denial trends to enable the team to adapt to changing payor challenges.

• Make daily leadership decisions and communicate these decisions to the relevant teams.

• Mentor, develop, delegate tasks, and lead teams effectively.

• Oversee programs and projects from inception to completion or implementation, including budget management and resource planning.

⛳️ Requirements

• Must hold an MD/DO degree (ESSENTIAL).

• Must reside in and be authorized to work in the United States.

• Expertise in utilization management as a physician.

• Capability to provide compliant status determinations for hospitalized patients.

• Proficiency in conducting peer-to-peer reviews with medical directors of payors.

• Ability to review short inpatient stays and observation patients effectively.

• Competence in assisting with denials and appeals processes.

• Skill in educating medical personnel on utilization management topics.

🏝️ Benefits

• Comprehensive benefits package that includes healthcare, paid time off, retirement plans, and well-being programs.

• Professional certification relevant to the associate's area of expertise.

• Tuition reimbursement opportunities.

• Incentive programs offered quarterly and annually.

• Flexibility in work-life balance.

• Opportunities for professional development.

• Remote work environment available.