Physician Advisor

About the Role

The Physician Advisor will provide physician advisor services designed to support and augment the health system’s utilization management, case management, revenue cycle, clinical documentation improvement, and related clinical operations.

What You'll Do

• medical necessity and patient status review;
• inpatient, outpatient, and observation status support;
• physician-to-physician consultation;
• payer peer-to-peer reviews and appeals;
• complex case and discharge barrier escalation including MDRs;
• post-acute care appeals;
• length-of-stay and readmission management support;
• physician engagement and education regarding utilization management, documentation, and applicable CMS and payer requirements.
• Other duties as assigned

Qualifications

• 1. Doctorate from an accredited Medical or Osteopathic School
• 2. 3 years of experience in a clinical practice
• 3. Prior experience in physician advisory OR certification as a physician advisor
• 4. Board Certified in applicable specialty
• 5. Active medical staff privileges at health system obtained within ninety (90) days of hire