Physician Advisor
Core
Provides leadership for efficiently managing resource and utilization to deliver quality cost effective care in the most appropriate setting.
Role type
Senior Physician Advisor (Utilization Management)
Builds
Care management protocols and utilization management processes for hospitals and physician groups
Domain
Healthcare revenue cycle management and utilization management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
status determinations for hospitalized patients, peer to peer reviews with payors, short inpatient stay reviews, observation patient reviews, medical staff education, UM committee participation, denial and appeals assistance, denial trend tracking
Preferred skills
relationship building with medical staff, program and project management, budget and resource planning
Technologies
none stated
Responsibilities
Perform peer to peer reviews with payors' medical directors, review observation patients daily, build relationships with medical staff leadership, attend UM committees as subject matter expert, assist with denials and appeals, educate medical staff on UM topics, track denial trends
Seniority
Senior, hands-on IC with leadership responsibilities