The Opportunity:

The Physician Advisor is responsible for 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. They review short inpatient stays and observation patients daily, while building strong relationships with medical staff and leadership to gain support for UM initiatives. Includes attending UM committees, assisting with denials and appeals, and educating medical staff on UM topics. The Physician Advisor partners with utilization review nurses, insurance authorization staff, and Case Management to strengthen UM processes, and tracks denial trends to help the team adapt to evolving payor challenges.

Leadership Decision Making - Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable. Drives results.

Coaching & Building Talent - Achieves results through other leaders by empowering them and providing feedback, instruction and development (coaching the coach) to develop their own associates; plans and supports the growth of individual skills and abilities in preparation for their next role (building bench); focuses on retention of high performers.

Delegation - Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement.

Leading Teams - Inspires and sustains team unity and engagement by developing, motivating, and guiding the team to achieve results together through productive relationships and work.

Executive Communication - Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others’ attention (appropriate, impactful and clear).

Program/Project Management - Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste and exceptional results.

Job Functions

• Status determinations for hospitalized patients

• Perform peer to peers with payors’ medical directors

• Short inpatient stay reviews

• Review observation patients daily

• Build relationship with medical staff and leadership to get their buy-in with UM issues

• Attend UM Committees as subject matter expert

• Assist with denials and appeals as appropriate

• Educate medical staff on UM topics

• Partner with UR nurses, IA staff, and Case Management to maintain and improve upon the UM process

• Track denial trends to assist the team evolve to meet new payor challenges

Employment Qualifications: MD/DO Physician (MUST have)

This position pays between $198,000- $297,000 based on relevant experience.