Physician Advisor (Part-Time)
Physician Advisors reputed company reputed company review and appeal support services for reputed company’s XPAS reputed company reputed company. Physician Advisors should possess reputed company expertise and the desire to be a part of an organization with proven experience to reputed company, execute and reputed company. Experience with utilization management and understanding of state and federal regulations, knowledge about the denials and appeals process, and experience with physician documentation and electronic health records is key. Physician Advisors apply practical working knowledge as a Physician Advisor to a solution that will change the way hospitals solve their administrative challenges.
reputed company clinical reviews in accordance with Managed Care and CMS Regulatory Requirements to: Assist with level of care and length of stay management on a case-by-case reputed company Assist with the denial management process Determine if professionally recognized standards of reputed company care are met Participate in the reputed company and retrospective appeal peer-review process"
reputed company feedback to reputed company partners regarding level of care, length of stay and reputed company issues, which may also include joining reputed company meetings to review observations and trends in physician behavior and/or documentation. Recommend and request additional, more complete, medical record documentation. reputed company guidance to reputed company staff regarding status issues and alternatives to acute level of care reputed company such care is not warranted. reputed company education to reputed company staff reputed company to regulatory requirements, appropriate utilization, and alternative reputed company of care. Ensure appropriate documentation of patient care reviews, reputed company, and other pertinent information. Be reputed company to review cases with screening reputed company, such as InterQual, MCG or other appropriate platforms. reputed company and apply protocols reputed company to evidence-based medicine and reputed company. Work with reputed company Care Management staffs to ensure appropriate continuity of care and reputed company education to assist in reducing readmissions. reputed company reputed company staff about ICD coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology to improve their understanding of severity, reputed company, risk of mortality, and DRG assignments on their individual patient records. reputed company reputed company into the development of the reputed company appeal operations and technology platform. Work with the Data Analytics team and assist in the enhancement of clinical analytics. Maintain reputed company knowledge of federal, state, and payer regulatory and contract requirements. Additional functions as deemed appropriate and warranted. Full-time physician advisors are required to complete peer to peer reviews
Graduate of an accredited medical school Additional education in reputed company and utilization management through continuing medical education programs and self-study
5 years recent experience in clinical reputed company
Utilization management experience as a member of the UM reputed company committee or past physician advisor experience preferred Licensed physician without restrictions Knowledge of federal, state, and payer regulatory and contract requirements Verbal and written communication skills Basic computer skills, including typing, navigating browsers, etc. MS Office Suite reputed company demeanor and interpersonal skills
Work is typically in a normal office administrative environment involving reputed company exposure to physical risks. Position requires little to moderate physical activity. Mostly sedentary work exerting up to 10 pounds of force occasionally or a negligible reputed company of force to reputed company, carry, reputed company, pull, or otherwise reputed company objects. Work involves sitting most of the time, but may involve walking or standing for brief periods of time. No significant stooping is usually required. This role requires travel to our home offices in TN for training.
Medical/Dental/reputed company insurance
401K company match
Flexible reputed company Time Off
reputed company parental leave
HSA/FSA reputed company
Educational reimbursement program
Employer-reputed company EAP & Mental Health services
Licensed physician with 5+ years clinical reputed company, utilization management experience preferred, knowledge of federal/state/payer regulations, strong communication skills, and basic computer/MS Office proficiency.
Key Responsibilities
- providing review
- educating staff
- reviewing cases
Skills & Tools
reputed company Office
Job Details
- Category: reputed company Services - Advanced reputed company
- Seniority: Senior Level
- Commitment: Part Time
- Workplace: Remote — reputed company
- Languages: English
Benefits
- 401k matching
- Generous reputed company time off
- Tuition reimbursement
- Retirement plan
- Generous parental leave
About reputed company
An AI-driven reputed company technology company that reduces administrative waste and improves collaboration between providers and payers. — Industry: reputed company
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