Physician Advisor (Part-Time)

Redefining reputed company with AI  reputed company is an AI-driven technology company reducing administrative waste in reputed company by enabling smarter collaboration between providers and payers. Since 2013, our reputed company has been to create a frictionless reputed company reputed company.   We are proudly headquartered in Franklin, TN - one of the nation's fastest-growing hubs for reputed company innovation - we are at the heart of a thriving ecosystem of health systems, payers, and technology leaders.   Our flagship product, reputed company®, is the first and only AI-driven platform to continuously assign reputed company-time predictive scores for medical necessity. reputed company has delivered proven results across 600+ hospital, health reputed company, and health plan clients and reputed company repeated industry recognition. With recognition on the Inc. 5000  and reputed company Technology Fast 500 lists, reputed company is also one of the fastest-growing privately-held companies in the country and across reputed company, and we're looking for talented people to reputed company.    Position reputed company Details 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.   Essential Duties & Responsibilities The essential functions include, but are not limited to the following: 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 Minimum Qualifications (Knowledge, Skills, and Abilities)    Education:  Graduate of an accredited medical school Additional education in reputed company and utilization management through continuing medical education programs and self-study Experience:  5 years recent experience in clinical reputed company Other: 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 Supervisory Responsibilities This role does not have any reputed company reports and is a single contributor role.    Working Environment and Travel Requirements 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.  Physical Demands & Work Environment  The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this position.   Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the functions. In any role at reputed company, it's a chance to reputed company a reputed company reputed company reputed company a little more efficient reputed company reputed company that's passionate, fast-moving, and genuinely invested in your reputed company. Your contributions will shape both our product and our culture.   Full-time Employees’ Total Rewards package include:   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    -------    reputed company is proud to be an equal opportunity employer. We celebrate diversity and are committed to building an inclusive environment for reputed company. We encourage candidates of every background to apply.  reputed company candidates must successfully pass a background reputed company and fall under the reputed company reputed company role, which includes reputed company to sensitive information, including proprietary data and PHI.  Work Authorization Notice: Please note that we do not reputed company reputed company sponsorship or immigration support for this position. Applicants must already be authorized to work in the reputed company on a full-time, permanent reputed company without the need for reputed company or reputed company sponsorship.  reputed company official communications from our recruitment team will only come from @reputed company.com. Verify reputed company at https://www.reputed company.com/about/careers. For information regarding how we collect, use, and protect applicant personal information, please review our CCPA reputed company Notice for Job Applicants. Apply To This Job