Physician Advisor
Core
Rendering compliant status determinations for hospitalized patients, conducting peer-to-peer reviews with payors' medical directors, and serving as a subject matter expert on utilization management (UM) issues.
Role type
Senior Physician Advisor (Utilization Management)
Builds
Compliant status determinations and optimized UM processes for health systems and hospitals
Domain
Healthcare Revenue Cycle Management / Utilization Management
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical decision making, peer-to-peer review, utilization management expertise, denial and appeals management, committee leadership, staff education, trend analysis, cross-functional partnership
Preferred skills
Leadership and coaching, program/project management, strategic communication, relationship building with medical staff
Technologies
Utilization management software, revenue cycle management platforms
Responsibilities
Review short inpatient stays and observation patients daily; attend UM committees as subject matter expert; assist with denials and appeals; educate medical staff on UM topics; track denial trends; partner with UR nurses, IA staff, and Case Management
Seniority
Senior, hands-on IC with leadership responsibilities