Physician Advisor

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

📋 Description

• Perform physician-to-physician evaluations to assess medical necessity, level of care, and to assist in denial prevention and appeals.

• Aid utilization review and case management teams with intricate clinical decision-making processes.

• Engage with the Physician Advisory team, hospital physicians, care coordination, and utilization management personnel to foster evidence-based care and documentation practices.

• Contribute to enhancing documentation related to ICD coding, severity of illness, risk of mortality, and DRG assignments.

• Stay updated with CMS and MCG evidence-based guidelines.

• Ensure compliance with legal, regulatory, accreditation, and payer partner standards.

• Achieve productivity and quality benchmarks within designated timeframes.

• Participate in mandatory training sessions and meetings.

• Join in peer review activities as required.

• Safeguard and disclose patient PHI in line with HIPAA regulations.

• Restrict PHI access to the minimum necessary for the tasks assigned.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• MD or DO with an active, unrestricted medical license.

• US Board Certified in an acknowledged specialty.

• At least 1 year of experience in payer or provider-side utilization review, or active ACPA and/or ABQUARP certification.

• Fundamental technical skills with hospital EMRs.

• In-depth knowledge of utilization management, medical necessity, and payer regulations.

• Familiarity with MCG/InterQual placement status criteria is preferred.

• Membership in the American College of Physician Advisors (ACPA) is preferred.

• Ability to effectively convey information in both formal and informal settings.

• Proficient in Microsoft Office Suite.

• Excellent interpersonal and communication abilities.

• Strong problem-solving and creative thinking skills, with sound judgment and the capacity to make decisions based on accurate and timely analysis.

• High integrity and reliability, demonstrating a strong sense of urgency and results-oriented mindset.

• Exceptional written and verbal communication capabilities.

• Competence in using a smartphone or electronic device that can download applications for multifactor authentication and security measures.

• Ability to follow directions, collaborate effectively with others, and manage stress efficiently.

🏝️ Benefits

• Multifactor authentication and security support via a required smartphone or electronic device.

• Adherence to HIPAA, information security, legal, regulatory, accreditation, and payer partner policies.

• Equal employment opportunity protections.