Physician Advisor
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Job Description
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.
Responsibilities:
- Render compliant status determinations for hospitalized patients
- Conduct peer-to-peer reviews with payors’ medical directors
- Review short inpatient stays and observation patients daily
- Build relationships with medical staff and leadership to gain support for utilization management initiatives
- Attend utilization management committees as a subject matter expert
- Assist with denials and appeals
- Educate medical staff on utilization management topics
- Partner with utilization review nurses, insurance authorization staff, and Case Management to maintain and improve utilization management processes
- Track denial trends to help the team adapt to evolving payor challenges
- Make day-to-day leadership decisions and communicate decisions to appropriate teams
- Coach, develop, delegate to, and lead teams
- Manage programs and projects from inception through completion or implementation, including budget and resource planning
Requirements:
- MD/DO Physician (MUST have)
- Must reside and be authorized to work within the United States
- Physician expertise in utilization management
- Ability to render compliant status determinations for hospitalized patients
- Ability to perform peer-to-peer reviews with payors’ medical directors
- Ability to review short inpatient stays and observation patients
- Ability to assist with denials and appeals
- Ability to educate medical staff on utilization management topics
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
- Remote work environment
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