Physician Advisor

Long Tail Health Solutions; Long Beach (CA); On-site; USD 210,000 - 290,000; Full time

Job summary

Long Tail Health Solutions seeks a Physician Advisor to support and augment utilization management, case management, revenue cycle, and clinical documentation improvement within a health system. The role involves medical necessity reviews, care status determinations, and physician-to-physician consultation to optimize outcomes and payer processes.

Qualifications include a Doctorate in medicine or osteopathy, 3 years of clinical practice, board certification, and active hospital privileges within

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.

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 CMS and payer requirements.

Skills

Medical knowledge

Clinical decision making

Physician communication

Utilization management

Education

Doctorate in medicine or DO

Job description

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

1. Doctorate from an accredited Medical or Osteopathic School
2. 3 years of experience in a clinical practice
3. Prior experience in physician advisory OR certification as a physician advisor
4. Board Certified in applicable specialty
5. Active medical staff privileges at health system obtained within ninety (90) days of hire