Physician Advisor II
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Physician Advisor leading medical-necessity reviews, utilization management, and documentation improvement for Med-Metrix. Mentoring advisors and managing healthcare client quality relationships.
Responsibilities:
- Lead the Physician Advisor team and mentor and teach internal and external stakeholders
- Maintain quality across the Physician Advisor team and manage PAOC client relationships
- Perform case reviews of all case types to achieve a high degree of compliance
- Respond to clinical review requests regarding medical necessity and other case management matters
- Consult with attending physicians, nurses, and case management staff on complex clinical issues, continued stay, medical necessity, and utilization management
- Apply MCG/InterQual criteria and professional judgment to patient-specific situations
- Support case management outcomes and clinical progression of patient care
- Recommend improvements to health record documentation affecting ICD code capture, severity, acuity, mortality risk, and DRG assignment
- Participate in Physician Advisor, Utilization Management, Care Management, and related training and education
- Meet production, quality, and performance standards
- Maintain patient and business 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
- 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
- Serve as Team Lead for Physician Advisor 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 and 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
- Possess a working knowledge of hospital organization, case management operations, and administrative standards and policies
- Proficiency in Microsoft Office Suite
- Strong interpersonal skills and ability to communicate well at all levels of the organization
- Strong problem-solving and creative skills, with the 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
- 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 possess 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
- Multifactor authentication and security device support requirement (smart-phone or electronic device capable of downloading applications)
Similar Jobs
Telehealth Physician
Telehealth Physician evaluating members and overseeing care plans for Carewell’s caregiving and care navigation services. Building clinical protocols, escalation pathways, and quality standards.
Mental Health Reviewing Physician
Mental health physician reviewing IME and FFDE records for public-safety employees. Providing fit-for-duty recommendations to federal contracting representatives.
General Radiologist
Remote general radiologist interpreting overnight emergency, inpatient, outpatient, stroke, and cross-sectional imaging. Supporting Baptist Health South Florida hospitals and imaging centers.
In-Home Health Physician, Part Time
Part-time physician conducting in-home health evaluations for Signify Health, part of CVS Health. Reviewing medical histories, performing physical evaluations, and connecting members to appropriate care.
Pediatric Radiologist, PRN
Remote PRN Pediatric Radiologist providing diagnostic and interventional pediatric imaging for Nemours Children’s Health. Interpreting examinations through an integrated PACS and collaborating across multi-site teams.
Physician Advisor
Physician Advisor guiding utilization management, denials, and appeals for Ensemble’s healthcare revenue cycle management clients. Conducting hospital status reviews and peer-to-peer payor consultations remotely nationwide.
Physician Advisor
Part-time Physician Advisor guiding utilization management for Ensemble, a healthcare revenue cycle management provider. Reviewing hospital stays, conducting payer reviews, and supporting denials, appeals, and medical staff education.
Telehealth Physician, FT
Telehealth Physician delivering preventive and chronic care to Medicare seniors for Belle. Conducting routine virtual visits, managing care plans, and coordinating with integrated clinical teams.
Virtual Primary Care Physician
Virtual primary care physician delivering video and message-based care for One Medical, an Amazon healthcare company. Managing acute, chronic, and preventive visits remotely.
Virtual Primary Care Physician
Virtual primary care physician delivering evidence-based telehealth for One Medical, a technology-enabled healthcare provider. Managing acute, chronic, and preventive care while overseeing NP and PA colleagues.
Virtual Primary Care Physician
Virtual primary care physician delivering evidence-based telehealth for One Medical, an accessible primary care healthcare platform. Managing acute, chronic, and preventive visits remotely.
Virtual Primary Care Physician
Virtual primary care physician delivering video and messaging-based care for One Medical, an Amazon healthcare company. Managing acute, chronic, and preventive visits while overseeing NP and PA colleagues.
Urgent Care, Telehealth Physician
Telehealth physician delivering virtual urgent care and observation services for Devoted Health’s older members. Supervising advanced practice providers and coordinating comprehensive care remotely.
Obesity Medicine Physician – Part-time
Obesity medicine physician providing remote, evidence-based chronic weight-management care for Form Health’s telemedicine clinic. Collaborating with APPs and dietitians while managing complex patient treatment.
Obesity Medicine Physician
Obesity Medicine Physician delivering virtual evidence-based weight-management care for Form Health’s telemedicine clinic. Collaborating with APPs and dietitians on multidisciplinary patient treatment.
Endocrinology Physician
Endocrinologist providing remote obesity and diabetes care through Form Health’s multidisciplinary telemedicine clinic. Managing complex diabetic comorbidities, CGMs, insulin pumps, and APP collaboration.
Endocrinology Physician – Part-time
Remote endocrinology physician providing obesity and complex diabetes care for Form Health’s virtual clinic. Managing telemedicine patients, CGMs, insulin pumps, and multidisciplinary APP collaboration.
Radiologist
Médico Radiologista interpretando exames de imagiologia e elaborando relatórios clínicos para cliente prestigiado da Synchro Health. Trabalho 100% remoto e flexível.
Clinical Geneticist – Physician
Remote Clinical Geneticist providing virtual genetic evaluations and consultations for VA Genomic Medicine Program beneficiaries. Ordering and interpreting genetic tests while coordinating treatment recommendations and care.
AIS Radiologist
Remote veterinary radiologist interpreting radiographs, ultrasound, MRI, and CT for Antech, a global veterinary diagnostics company. Providing specialist reports and consultations to support animal healthcare.