Part Time Physician Advisor - Pittsburgh, PA
Core
Supports Forbes Hospital and Allegheny Valley Hospital by aligning patient needs with regulatory and payer requirements for medical necessity, level of care, and care setting.
Role type
Physician Advisor (Utilization Management)
Builds
Patient flow, quality initiatives, and denial prevention programs
Domain
Healthcare / Hospital Operations
Required skills
Medical necessity review, level-of-care determination, peer-to-peer discussions, utilization management, interdisciplinary collaboration, clinical documentation improvement, performance trend analysis, medical staff credentialing
Preferred skills
Physician advising certification, healthcare quality training, acute-care leadership, integrated payer-provider experience
Technologies
None stated
Responsibilities
Review admissions, observation services, and continued stays for medical necessity; Conduct peer-to-peer discussions with payer medical directors; Collaborate with physicians and case managers to resolve complex cases; Participate in interdisciplinary rounds to improve quality and throughput; Provide clinical education on payer requirements and documentation; Lead action plans based on performance dashboard trends.
Seniority
Mid-Senior, hands-on IC