Physician Advisor

lths-main; Long Beach (CA); On-site; USD 200,000 - 280,000; Full time

Job summary

Long Tail Health Solutions Inc. is seeking a Physician Advisor to support utilization management, case management, and related clinical operations across a health system. You will review medical necessity, patient status, and engage in physician-to-physician consultations with payer peers.

Responsibilities include managing inpatient/outpatient status, MDRs, discharge barriers, and post-acute appeals, while educating clinicians on CMS and payer requirements.

Qualifications

• Doctorate from an accredited Medical or Osteopathic School.
• 3 years of experience in a clinical practice.
• Certification as a physician advisor or equivalent experience.

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 and CMS/payer requirements.
• Other duties as assigned

Education

Doctorate from an accredited Medical or Osteopathic School

Board Certified in applicable specialty

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.

Our mission is to optimize the financial performance and work-lives of healthcare providers by eliminating administrative waste with modern technology applied to long tail problems.

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