Physician Advisor II

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

📋 Description

• Lead the Physician Advisor team while mentoring and educating both internal and external stakeholders.

• Ensure quality standards across the Physician Advisor team and manage client relationships for PAOC.

• Conduct case reviews for all case types to ensure a high level of compliance.

• Address clinical review inquiries related to medical necessity and other case management issues.

• Collaborate with attending physicians, nurses, and case management personnel on intricate clinical matters, continued stays, medical necessity, and utilization management.

• Utilize MCG/InterQual criteria along with professional judgment in patient-specific cases.

• Support case management results and the clinical advancement of patient care.

• Suggest enhancements to health record documentation that impact ICD code capture, severity, acuity, mortality risk, and DRG assignments.

• Engage in training and education related to Physician Advisor, Utilization Management, Care Management, and other relevant areas.

• Meet established production, quality, and performance expectations.

• Uphold patient and business confidentiality while adhering to HIPAA and information security regulations.

• Facilitate, mentor, and instruct physicians on payer requirements.

• Attend meetings and partake in peer reviews as needed.

• Oversee PAOC client relationships, quarterly reporting, and Joint Operating Committees (JOCs).

• Contribute to PAOC’s quality initiatives and ongoing development of Physician Advisors.

• Provide education to client-facility staff on pertinent topics.

• Mentor and train both new and existing Physician Advisors.

• Act as Team Lead for Physician Advisor dashboard management when assigned.

• Perform additional duties as required.

⛳️ Requirements

• Board Certified in a specialty.

• Licensed to practice medicine in the United States.

• A minimum of 3 years of experience as a Physician Advisor or UR/UM Medical Director with case review responsibilities.

• Basic technical proficiency with hospital EMRs and Microsoft Office and Teams.

• Maintain an unrestricted medical license and Board Certification.

• Have or develop a solid foundation, knowledge, and/or experience in utilization management, quality improvement, and patient safety.

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

• Proficient in the Microsoft Office Suite.

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

• Excellent problem-solving and creative thinking abilities, with the capacity to exercise sound judgment and make decisions based on accurate and timely information.

• High integrity and reliability with a strong sense of urgency and focus on results.

• Outstanding written and verbal communication skills.

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

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

• Board Certification by ABQAURP is preferred.

• Physician Advisor Sub-Specialty Certification by ABQAURP is preferred.

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

🏝️ Benefits

• Requirement for holiday coverage of up to 3 holidays per year.

• Support for multifactor authentication and security devices (smartphone or electronic device capable of downloading applications).