Physician Advisor

Long Tail; Long Beach (CA); On-site; USD 180,000 - 250,000; Full time

Job summary

Long Tail Health Solutions Inc. is seeking a Physician Advisor to support utilization management, case management, revenue cycle, clinical documentation improvement, and related clinical operations in a health system setting.

You will perform medical necessity and patient status reviews, advise on inpatient/outpatient/observation status, and collaborate with physicians and payers to address CMS and payer requirements.

Qualifications

• Doctorate from an accredited Medical or Osteopathic School.
• 3 years of experience in a clinical practice.
• Experience in physician advisory OR certification as a physician advisor.
• Board Certified in applicable specialty.
• Active medical staff privileges obtained within ninety (90) days of hire.

Responsibilities

• medical necessity and patient status review;
• inpatient, outpatient, and observation status support;
• physician-to-physician consultation;
• payer peer-to-peer reviews and appeals;
• complex case and discharge barrier escalation including MDRs;
• post-acute care appeals;
• length-of-stay and readmission management support;
• physician engagement and education regarding utilization management, documentation, and applicable CMS and payer requirements.
• Other duties as assigned

Skills

Medical knowledge

Clinical judgment

Communication with physicians

Payer policy understanding

Education

MD/DO Doctorate

Board Certification

Job description

About Long Tail Health Solutions Inc.

Long Tail Health Solutions is a provider advocate, delivering a suite of technology-enabled services which discover and operationalize payer rules and behaviors to improve the visibility, execution, and outcomes of utilization review, case management, and revenue cycle functions.

About The Role

The Physician Advisor will provide physician advisor services designed to support and augment the health system’s utilization management, case management, revenue cycle, clinical documentation improvement, and related clinical operations.

What You’ll Do

• medical necessity and patient status review;
• inpatient, outpatient, and observation status support;
• physician-to-physician consultation;
• payer peer-to-peer reviews and appeals;
• complex case and discharge barrier escalation including MDRs;
• post-acute care appeals;
• length-of-stay and readmission management support;
• physician engagement and education regarding utilization management, documentation, and applicable CMS and payer requirements.

• Other duties as assigned

Qualifications

• Doctorate from an accredited Medical or Osteopathic School
• 3 years of experience in a clinical practice
• Prior experience in physician advisory OR certification as a physician advisor
• Board Certified in applicable specialty
• Active medical staff privileges at health system obtained within ninety (90) days of hire