Per Diem Physician Advisor

Apex Home Health, Hospice & Home Care; Wethersfield (CT); On-site; USD 150,000 - 210,000; Full time

Job summary

Apex Home Health, Hospice & Home Care is seeking a Physician Advisor to collaborate with clinical resource management nurses, attending physicians, and hospital leadership. The role focuses on appropriate utilization of healthcare resources and accurate level-of-care decisions.

You will perform physician reviews, engage in payer discussions, support appeals, ensure regulatory compliance, and educate clinicians to promote evidence-based utilization practices and ongoing quality improvement.

Qualifications

• Physician-level expertise in clinical decision-making and patient care.
• Strong collaboration and communication with multidisciplinary teams.
• Knowledge of utilization management, payer review processes, and appeals support.
• Understanding of healthcare regulations and compliance expectations.
• Ability to educate and influence practice while supporting quality improvement efforts.

Responsibilities

• Perform physician reviews to support clinical decision-making and appropriate care placement.
• Collaborate on payer discussions and resolve utilization-related concerns.
• Support appeals processes with clinical documentation and physician input.
• Ensure regulatory compliance in utilization management and related processes.
• Provide physician education to promote consistent, evidence-based utilization practices.
• Drive quality improvement initiatives tied to utilization outcomes and care appropriateness.

Skills

Clinical decision-making

Collaboration

Payer review knowledge

Regulatory understanding

Job description

Physician Advisor partners with clinical resource management nurses, attending physicians, and hospital leadership to support appropriate utilization of healthcare resources and accurate level-of-care decisions.

Key Responsibilities

• Perform physician reviews to support clinical decision-making and appropriate care placement.
• Collaborate on payer discussions and resolve utilization-related concerns.
• Support appeals processes with clinical documentation and physician input.
• Ensure regulatory compliance in utilization management and related processes.
• Provide physician education to promote consistent, evidence-based utilization practices.
• Drive quality improvement initiatives tied to utilization outcomes and care appropriateness.

Required Skills/Qualifications

• Physician-level expertise in clinical decision-making and patient care.
• Strong collaboration and communication with multidisciplinary clinical and leadership teams.
• Knowledge of utilization management, payer review processes, and appeals support.
• Understanding of healthcare regulations and compliance expectations.
• Ability to educate and influence practice while supporting quality improvement efforts.