Physician Advisor

Ensemble Health Partners; Blue Ash (OH); On-site; USD 198,000 - 297,000; Full time

Benefits offered by this job

Comprehensive benefits package

Tuition reimbursement

Professional certification support

Job summary

Ensemble Health Partners seeks an experienced Physician Advisor to lead utilization management across hospital services, ensuring appropriate levels of care and documentation. You will work with medical leadership to optimize resource use, provide education to staff, and report to executive committees.

A strong background in peer-to-peer reviews and denials management is essential. Role requires MD/DO, certification, and a collaborative approach to drive compliant, cost-effective care.

Qualifications

• MD/DO physician licensed and board-certified (or eligible).
• Experience in utilization management and peer-to-peer review is a plus.

Responsibilities

• Determine status for hospitalized patients and perform peer-to-peer reviews with payor medical directors.
• Conduct short inpatient stay reviews and daily observation reviews.
• Educate medical staff on utilization management topics and protocols.
• Partner with UR nurses, IA staff and Case Management to improve UM processes.
• Attend UM committees as subject matter expert and provide data-driven insights.
• Assist with denials and appeals as appropriate.
• Track denial trends to adapt to payor requirements.

Skills

Leadership

Program/Project Management

Education

MD/DO Physician (MUST have)

Job description

Thank you for considering a career at Ensemble!Ensemble 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 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.Leadership Decision Making - Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable. Drives results.Coaching & Building Talent - Achieves results through other leaders by empowering them and providing feedback, instruction and development (coaching the coach) to develop their own associates; plans and supports the growth of individual skills and abilities in preparation for their next role (building bench); focuses on retention of high performers.Delegation - Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement.Leading Teams - Inspires and sustains team unity and engagement by developing, motivating, and guiding the team to achieve results together through productive relationships and work.Executive Communication - Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others’ attention (appropriate, impactful and clear).Program/Project Management - Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste and exceptional results.Job FunctionsStatus determinations for hospitalized patientsPerform peer to peers with payors’ medical directorsShort inpatient stay reviewsReview observation patients dailyBuild relationship with medical staff and leadership to get their buy-in with UM issuesAttend UM Committees as subject matter expertAssist with denials and appeals as appropriateEducate medical staff on UM topicsPartner with UR nurses, IA staff, and Case Management to maintain and improve upon the UM processTrack denial trends to assist the team evolve to meet new payor challengesEmployment Qualifications: MD/DO Physician (MUST have)This position pays between $198,000- $297,000 based on relevant experience.Join an award-winning companyFive-time winner of “Best in KLAS” 2020-2022, 2024-2025Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-202422 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023Energage Top Workplaces USA 2022-2024Fortune Media Best Workplaces in Healthcare 2024Monster Top Workplace for Remote Work 2024Great Place to Work certified 2023-2024InnovationWork-Life FlexibilityLeadershipPurpose + ValuesBottom 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 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 also prohibits harassment of applicants or employees based on any of these protected categories.Due to business, operational, payroll, and regulatory requirements, this position is limited to individuals who reside and are authorized to work within the United States. Applications generated from outside the United States will not be considered. Individuals may reapply when located within the United States.Ensemble 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] 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.Employment Disclaimers – Ensemble