Per Diem Utilization & Care Optimization Physician

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

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.