Onsite Physician Advisor - Latrobe, PA (Pittsburgh area)

Optum; Greensburg (Westmoreland County); On-site; USD 150,000 - 190,000; Full time

Job summary

Optum is seeking a Physician Advisor to join the hospital-based team. The PA will help ensure appropriate utilization of health care services, develop expertise in medical necessity and documentation, and participate in peer-to-peer discussions with payors.

The role requires working on-site at the facility Monday through Friday, collaborating with medical staff, house staff, and leadership to optimize patient status and utilization management processes.

Qualifications

• MD or DO is required.
• Current, unrestricted medical license in Pennsylvania.
• 3+ years of experience in a hospital-based practice setting.

Responsibilities

• Conduct second level medical necessity/compliance status reviews for all payor types
• Meet with case management, utilization management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status through case reviews
• Interacting with medical staff to discuss medical necessity and concurrent denial cases
• Act as a consultant for the medical staff regarding their decisions for the appropriate medical necessity status of hospitalized patients and supporting documentation
• Participate in the claims denial process by conducting peer to peer discussions with commercial payor medical directors for cases that have been denied concurrently
• Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application

Education

MD or DO

Job description

The Physician Advisor (PA) is employed by Optum, the intention is that the PA will become a key member of the client hospital's team charged with meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. To this end, the PA will develop expertise on matters regarding medical necessity, documentation best practices and concurrent denial payor peer to peer interactions. Physician Advisor will be required to work onsite at the facility M-F during standard facility business hours.

The Physician Advisor will work closely with medical staff, including house staff and actively engage with hospital leadership and utilization management teams related to both medical necessity status reviews and concurrent denial reviews.

• Conduct second level medical necessity/compliance status reviews for all payor types
• Meet with case management, utilization management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status through case reviews
• Interacting with medical staff to discuss medical necessity and concurrent denial cases
• Act as a consultant for the medical staff regarding their decisions for the appropriate medical necessity status of hospitalized patients and supporting documentation
• Participate in the claims denial process by conducting peer to peer discussions with commercial payor medical directors for cases that have been denied concurrently
• Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application

Required Qualifications:

• MD or DO
• Current, unrestricted medical license in Pennsylvania
• 3+ years of experience in a hospital-based practice setting