Physician Advisor
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Job Description
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.
Responsibilities:
- Render compliant status determinations for hospitalized patients
- Conduct peer-to-peer reviews with payors' medical directors
- Serve as a subject matter expert on utilization management issues
- Review short inpatient stays and observation patients daily
- Build relationships with medical staff and leadership to support utilization management initiatives
- Attend utilization management committees
- Assist with denials and appeals
- Educate medical staff on utilization management topics
- Partner with utilization review nurses, insurance authorization staff, and Case Management to strengthen utilization management processes
- Track denial trends and help the team adapt to evolving payor challenges
Requirements:
- Physician role involving utilization management and physician advisory responsibilities
- Must reside and be authorized to work within the United States
- Applications from outside the United States will not be considered
- Knowledge of utilization management issues
- Ability to conduct peer-to-peer reviews with payors' medical directors
- Ability to review short inpatient stays and observation patients
- Ability to collaborate with utilization review nurses, insurance authorization staff, and Case Management
- Ability to attend utilization management committees
- Ability to assist with denials and appeals
- Ability to educate medical staff on utilization management topics
- Ability to track denial trends and adapt to evolving payor challenges
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 for employees who go beyond expectations
- Work-life flexibility
- Professional development opportunities
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