Lead Physician Advisor

Ensemble Health Partners; United States; Remote; USD 150,000 - 200,000; Full time

Job summary

Ensemble Health Partners seeks a Lead Physician Advisor to oversee resource management for quality care delivery. This role involves collaborating with medical staff, training, and optimizing hospital services. Ideal candidates will possess an M.D. and board certification, bringing strong leadership and clinical judgement to the team.

Benefits

Comprehensive benefits package

Professional certification support

Tuition reimbursement

Quarterly and annual incentive programs

Flexible work-life balance initiatives

Qualifications

• M.D. or equivalent with board certification in a relevant specialty required.
• Strong leadership and compliance knowledge essential.
• Experience in utilization management preferred.

Responsibilities

• Lead resource and utilization management to deliver quality care.
• Facilitate local system utilization management training.
• Develop statistical reports related to revenue improvement.

Skills

Clinical judgement

Communication

Leadership

Utilization management

Compliance knowledge

Education

Doctor of Medicine (M.D.) or equivalent

Board certification in a relevant specialty

Job description

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!

O.N.E Purpose:

• Customer Obsession:Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

• Embracing New Ideas:Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

• Striving for Excellence:Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:

The Lead Physician Advisor provides leadership for efficiently managing resource and utilization to deliver quality cost- effective care in the most appropriate setting. Works closely with the medical staff leadership, the entire medical staff, including resident physician house staff in all areas of resource/utilization management to develop and implement methods to optimize use of hospital services for all patients. This includes working with hospital leadership in developing care management protocols with physicians and others to optimize efficient management of resources, insuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, performing Peer to Peer reviews, Short Stay Reviews, Extended Observation. Provides for medical staff education and training as required. Provides periodic reports to Board, MEC and Joint Conference as deemed necessary.

Essential Job Functions

• Maintains accountability for achieving utilization / resource management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care.

• Reviews issues identified by UR staff to ensure appropriate follow-up, recommend improvement initiatives as needed, and make referrals to the appropriate department chair as necessary.

• Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Utilization department in a timely fashion.

• Provides consultation to nurses and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management.

• Provides for development and dissemination of required protocols, policy and procedures to support revenue cycle goals and compliance with regulations.

• Participate in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested.

• Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable.

• Facilitates local system utilization management training and education to Boards, MEC and medical staff departments as required.

• Provides for coordination and improvement in QIO audits.

• Develops statistical reports related to revenue improvement and denial reduction within scope and as requested by Local System Boards, MEC and other local system committees.

• Work with Human Resources on orientation, orientation handbook, compliance, scheduling, training, client engagement, quality and dashboards.

• Collaborate with other departments, attend company meetings and coordinate and provide updates on new processes, policies and procedures.

• Deliver bi-monthly and yearly evaluations.

• Lead weekly, quarterly meetings and develop webinar presentations.

• Grow Physician Advisory program through speaking at conferences, webcasts and podcasts.

• Collaborate with payors to establish strategies to work together.

Join an award-winning company

Five-time winner of “Best in KLAS” 2020-2022, 2024-2025

Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024

22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024

Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024

Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023

Energage Top Workplaces USA 2022-2024

Fortune Media Best Workplaces in Healthcare 2024

Monster Top Workplace for Remote Work 2024

Great Place to Work certified 2023-2024

• Innovation

• Work-Life Flexibility

• Leadership

• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits – We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact [e-mail].

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range.

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