Physician Advisor – Exempt
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Job Description
Physician Advisor leading utilization management, peer reviews, and hospital resource optimization. Supporting Ensemble’s technology-enabled revenue-cycle solutions for health systems nationwide.
Responsibilities:
- Provide leadership for resource and utilization management to deliver quality, cost-effective care in the appropriate setting
- Work with medical staff leadership, physicians, and resident house staff on resource and utilization management
- Develop and implement methods to optimize hospital service utilization
- Develop care management protocols with hospital leadership, physicians, and others
- Ensure patients are in the appropriate level of care
- Support documentation, coding improvements, and compliance
- Perform peer-to-peer reviews, short-stay reviews, and extended observation reviews
- Provide medical staff education and training
- Prepare periodic reports for the Board, MEC, and Joint Conference
- Determine status for hospitalized patients
- Review observation patients daily
- Build relationships with medical staff and leadership regarding utilization management issues
- Attend utilization management committees as a subject matter expert
- Assist with denials and appeals
- Partner with UR nurses, IA staff, and Case Management to improve the utilization management process
- Track denial trends and help the team respond to payer challenges
Requirements:
- MD/DO Physician (MUST have)
- Must reside and be authorized to work within the United States
- Experience relevant to compensation determination
- Medical licensure required to practice as an MD/DO physician (implied by the mandatory physician qualification)
Benefits:
- Comprehensive benefits package including healthcare, time off, retirement, and well-being programs
- Professional certification relevant to the associate’s field
- Tuition reimbursement
- Quarterly and annual incentive programs
- Work-life flexibility
- Professional development opportunities
- Reasonable accommodations for qualified individuals with disabilities
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