Physician Advisor II

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

📋 Description

• Addresses requests for assistance concerning clinical reviews related to medical necessity or other matters from any member of the Case Management department promptly.

• Offers consultation to attending physicians, nurses, and case management personnel on intricate clinical issues and provides guidance on the justification needed for continued patient stay, medical necessity, and utilization management.

• Develops a thorough understanding and working knowledge of established published criteria such as MCG/InterQual, applying professional judgment and patient-specific factors as required or justified.

• Takes responsibility for achieving case management outcomes and meets the obligations and responsibilities of the role to support medical staff in the clinical progression of patient care.

• Suggests improvements for health record documentation that specifically influence ICD code assignment relating to severity, acuity, risk of mortality, and DRG assignment.

• Engages in ongoing training and education pertinent to the Physician Advisor role and responsibilities, including topics related to Utilization Management, Care Management, and other relevant areas as requested.

• Adheres to production standards within set timeframes, ensuring that work products and performance meet quality criteria.

• Achieves performance objectives as specified in the employment agreement.

• Maintains the confidentiality of patient care and business matters.

• Exhibits behavior that aligns with the organization’s mission, participating in required orientation and training related to the Physician Advisor role.

• Demonstrates commitment to meeting or exceeding the strategic initiatives of the organization.

• Upholds the organization’s values of teamwork and professionalism, applying Code of Conduct standards to all members of the healthcare team.

• Facilitates, mentors, and educates other physicians on payer requirements.

• Attends all meetings as requested by PAOC leadership.

• Participates in the peer review process as necessary or upon request.

• Maintains medical licensure and board certification in good standing.

• Manages client relationships for PAOC, overseeing quarterly report creation and JOCs (in collaboration with the Director of Operations), while ensuring customer satisfaction and retention.

• Contributes to the implementation of PAOC’s Quality program and continuous professional development.

• Provides education to staff at client facilities on a variety of relevant topics.

• Mentors and trains both new and existing Physician Advisors to ensure the highest consistency and quality for PAOC determinations.

• Serves as Team Lead for Physician Advisors regarding Dashboard management as scheduled.

• Completes additional responsibilities as needed within the Physician Advisor II role.

• Performs other assigned duties.

⛳️ Requirements

• Board Certified in a medical specialty.

• Licensed to practice medicine in the United States.

• Over 3 years of experience as a Physician Advisor or UR/UM Medical Director conducting case reviews.

• Basic technical proficiency with Hospital EMRs and Microsoft Office and Teams is essential.

• Must hold and maintain an unrestricted medical license and Board Certification.

• Should possess or acquire a solid foundation, knowledge, and/or experience in utilization management, quality improvement, and patient safety.

• Must have a working knowledge of hospital organization, case management operations, and administrative standards and policies.

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

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

• Board Certification from the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is preferred.

• Physician Advisor Sub-Specialty Certification from the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is preferred.

• Proficient in Microsoft Office Suite.

• Strong interpersonal skills with the ability to communicate effectively at all organizational levels.

• Excellent problem-solving and creative skills, along with the capability to exercise sound judgment and make decisions based on accurate and timely analyses.

• High integrity and dependability with a strong sense of urgency and results-driven approach.

• Outstanding written and verbal communication skills are required.

🏝️ Benefits

• Must have a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.