Physician Advisor

Long Tail Health Solutions Inc.; Long Beach (CA); On-site; USD 150,000 - 230,000; Full time

Job summary

Long Tail Health Solutions Inc. in Long Beach, CA, seeks a Physician Advisor to support utilization management, case management, and revenue cycle operations within a health system.

The role involves medical necessity reviews, inpatient/outpatient status support, payer peer-to-peer reviews, complex case escalation, and physician engagement to ensure CMS and payer compliance. A Doctorate in Medicine or Osteopathy and 3 years of clinical practice are required, with board certification and active

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;
• payer peer-to-peer reviews and appeals;
• complex case and discharge barrier escalation including MDRs;
• 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

Physician advisor

Education

Doctorate in Medicine or Osteopathic

Job description

Physician Advisor

Long Tail Health Solutions Inc. Long Beach, California, United States

About this position

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;
• payer peer-to-peer reviews and appeals;
• complex case and discharge barrier escalation including MDRs;
• 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