University of Massachusetts Medical School

Physician Advisor

University of Massachusetts Medical School • $180K — $220K *
Westborough, MA 01581In-Person
Healthcare
5 - 7 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Board eligible or certified in area of specialty
  • Minimum of 5 years of experience in direct patient care
  • Proven ability to prioritize and plan work efficiently
  • Excellent problem-solving and decision-making skills

Responsibilities

  • Determine eligibility for public assistance benefits based on clinical criteria
  • Review medical records to approve or deny recommendations from Registered Nurse Reviewers
  • Advise review team on the functional capabilities of applicants based on comprehensive record reviews
  • Contribute to quality improvement initiatives within the department
  • Participate in quality team case reviews
  • Collaborate with leadership to develop clinical policies and quality evaluations
  • Evaluate and propose solutions for case-specific issues
  • Train new Physician Advisors

Benefits

  • Collaborative work environment with clinical and leadership teams
  • Opportunity to influence clinical policy and quality initiatives
  • Participation in quality improvement programs
  • Mentorship opportunities for new advisors
  • Engagement in case reviews to enhance decision-making practices
Full Job Description
Overview

GENERAL SUMMARY OF POSITION:

Under the general direction of the Medical Director, Director, or designee, the Physician Advisor is responsible for reviewing applicant medical records and making a clinical determination of eligibility for applicants seeking benefits and/or long term care services based on clinical guidelines. The Physician Advisor also provides clinical guidance reviewers and quality improvement initiatives as appropriate.

Responsibilities

MAJOR RESPONSIBILITIES:
  • Responsible for determining whether an individual applying for and/or receiving public assistance benefits/services meets specific clinical and functional criteria outlined in federal and state regulations
  • Review medical records, approves or denies recommendations made by Registered Nurse Reviewers regarding the status of an applicant or member
  • Participates in and advises review team regarding the functional capability of an applicant based upon a comprehensive review of all records
  • Contributes to quality improvement initiatives developed within the program or department
  • Participates in quality team case reviews
  • Collaborate with department leadership in the interpretation of all applicable regulations, development of clinical policies and quality evaluations, and provide feedback to clinical staff regarding clinical policies and the outcomes of quality evaluations
  • Evaluates and develops alternatives to address problems and issues as they arise on a case by case basis
  • Participates as a member of clinical or case review teams
  • Responsible for training new Physician Advisors
  • Performs other duties as assigned.


Qualifications

REQUIRED QUALIFICATIONS:
  • Board eligible or certified in area of specialty
  • Minimum of 5 years of experience in direct patient care
  • Proven ability to plan and prioritize work in order to meet position objectives or job responsibilities
  • Excellent problem solving and decision making capabilities

About University of Massachusetts Medical School

The University of Massachusetts Medical School (UMMS) is a world-class research institution with a uniquely collaborative spirit, that consistently produces noteworthy advances in clinical and basic research. The school is located in Worcester, Massachusetts and is part of the University of Massachusetts system. UMMS is dedicated to advancing the health and well-being of the people of the commonwealth and the world through pioneering advances in education, research, and health care delivery. The school is home to three Nobel laureates, 25 research centers, and a faculty of more than 1,200 physicians, scientists, and health care professionals.
Learn more about University of Massachusetts Medical School
Size
6,000 employees
Industry
Education, Government & Non-Profit
Founded
1894
* Ladders Estimates

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