Physician Advisor II – MD Required

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

📋 Description

• Lead and mentor the Physician Advisor team, providing education and guidance to both internal and external Physician Advisors.

• Conduct case reviews across all types to ensure compliance.

• Address requests for clinical review assistance related to medical necessity and additional issues.

• Collaborate with attendings, nurses, and case management personnel on intricate clinical matters, continued-stay justification, medical necessity, and utilization management.

• Utilize MCG/InterQual criteria and professional judgment for patient-specific evaluations.

• Support case management outcomes and the clinical progression of patient care.

• Suggest enhancements to health record documentation that influence ICD code capture, severity, acuity, risk of mortality, and DRG assignment.

• Engage in training for Physician Advisors, utilization management, care management, and other related areas.

• Achieve production, quality, and performance benchmarks.

• Uphold confidentiality and adhere to HIPAA and information security regulations.

• Facilitate and educate physicians about payer requirements.

• Attend meetings and partake in peer review as needed.

• Oversee PAOC client relationships, quarterly reports, and JOCs to enhance customer satisfaction and retention.

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

• Educate staff at client facilities on pertinent subjects.

• Mentor and train both new and existing Physician Advisors to ensure consistency and quality.

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

• Execute additional responsibilities as required.

⛳️ Requirements

• Board Certified in a 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, Microsoft Office, and Teams.

• Maintain an unrestricted medical license and Board Certification.

• Possess or develop a comprehensive understanding, knowledge, and/or experience in utilization management, quality improvement, and patient safety.

• Familiar with hospital organization, case management operations, and administrative standards and policies.

• Preferred familiarity with MCG/InterQual placement status criteria.

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

• ABQAURP Board Certification is preferred.

• ABQAURP Physician Advisor Sub-Specialty Certification is preferred.

• Proficient in the Microsoft Office Suite.

• Strong interpersonal and communication abilities.

• Excellent problem-solving and creative skills; capable of exercising sound judgment and making decisions based on accurate and timely analyses.

• High degree of integrity and reliability with a strong sense of urgency and results-driven orientation.

• Exceptional written and verbal communication skills are essential.

• Availability to work assigned shifts from Monday to Friday, between 8 a.m. and 5 p.m. EST to 9 a.m. and 6 p.m. EST.

• Capability to utilize a smartphone or electronic device for downloading applications for multifactor authentication and security purposes.

🏝️ Benefits

• Coverage requirement for up to 3 holidays per year.

• Assigned shifts from Monday to Friday.

• Option for remote work arrangements.

• Provision of required smartphone or electronic device for multifactor authentication and security purposes.