Physician Advisor II – MD Required
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Job Description
Remote Physician Advisor II leading medical-necessity reviews and utilization management for Med-Metrix healthcare clients. Mentoring advisors and managing client quality, compliance, and documentation initiatives.
Responsibilities:
- Lead the Physician Advisor team and mentor, teach, and educate Physician Advisors internally and externally
- Perform case reviews of all case types to achieve compliance
- Respond to clinical review assistance requests regarding medical necessity and other matters
- Consult with attendings, nurses, and case management staff on complex clinical issues, continued-stay justification, medical necessity, and utilization management
- Apply MCG/InterQual criteria and professional judgment to patient-specific cases
- Support case management outcomes and clinical progression of patient care
- Recommend improvements to health record documentation affecting ICD code capture, severity, acuity, risk of mortality, and DRG assignment
- Participate in Physician Advisor, utilization management, care management, and related training
- Meet production, quality, and performance standards
- Maintain confidentiality and comply with HIPAA and information security policies
- Facilitate, mentor, and educate physicians regarding payer requirements
- Attend meetings and participate in peer review as requested
- Manage PAOC client relationships, quarterly reports, and JOCs to support customer satisfaction and retention
- Contribute to PAOC’s quality program and continuous Physician Advisor development
- Educate client-facility staff on relevant topics
- Mentor and train new and existing Physician Advisors for consistency and quality
- Serve as Physician Advisor Team Lead for dashboard management when scheduled
- Perform additional duties as assigned
Requirements:
- Specialty Board Certified
- Licensed to practice medicine in the US
- 3+ years working as a Physician Advisor or UR/UM Medical Director performing case reviews
- Basic technical skills with Hospital EMRs, Microsoft Office, and Teams
- Hold and maintain an unrestricted medical license and Board Certification
- Possess or acquire a solid foundation, knowledge, and/or experience in utilization management, quality improvement, and patient safety
- Working knowledge of hospital organization, case management operations, and administrative standards and policies
- Familiarity with MCG/InterQual placement status criteria preferred
- Membership in the American College of Physician Advisors (ACPA) preferred
- ABQAURP Board Certification preferred
- ABQAURP Physician Advisor Sub-Specialty Certification preferred
- Proficiency in Microsoft Office Suite
- Strong interpersonal and communication skills
- Strong problem-solving and creative skills; ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results orientation
- Excellent written and verbal communication skills required
- Ability to work assigned Monday–Friday shifts from 8 a.m.–5 p.m. EST to 9 a.m.–6 p.m. EST
- Ability to use a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
Benefits:
- Holiday coverage requirement of up to 3 holidays per year
- Monday to Friday assigned shifts
- Remote work arrangement
- Required smartphone or electronic device supplied/used for multifactor authentication and security purposes
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