Physician Advisor

Ensemble Health Partners; Ohio; Remote; USD 198,000 - 297,000; Full time

Job summary

Ensemble Health Partners is seeking a Physician Advisor to render compliant statuses for hospitalized patients, perform peer reviews with payors, and act as a UM expert. The role emphasizes collaboration with medical staff, attending UM committees, and guiding denials and appeals.

Remote position with occasional onsite travel; requires MD/DO and ability to translate AI insights into improved business outcomes within healthcare revenue cycle management.

Qualifications

• MD/DO physician with demonstrated AI expertise translating AI insights into business outcomes.
• Ability to work remotely and travel to client sites as needed.

Responsibilities

• Render compliant status determinations for hospitalized patients.
• Conduct peer-to-peer reviews with payors' medical directors.
• Serve as subject matter expert on utilization management (UM) issues.
• Review short inpatient stays and observation patients daily.
• Collaborate with medical staff and leadership to gain buy-in for UM initiatives.
• Attend UM committees and assist with denials/appeals.
• Educate medical staff on UM topics.
• Partner with UR nurses, IA staff, and Case Management to improve UM processes.
• Track denial trends to adapt to payor challenges.

Skills

MD/DO Physician

AI in business outcomes

Education

MD/DO

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 is responsible for rendering compliant status determinations for hospitalized patients, conducting peer-to-peer reviews with payors' medical directors, and serving as a subject matter expert on utilization management (UM) issues. They review short inpatient stays and observation patients daily, while building strong relationships with medical staff and leadership to gain support for UM initiatives. Includes attending UM committees, assisting with denials and appeals, and educating medical staff on UM topics. The Physician Advisor partners with utilization review nurses, insurance authorization staff, and Case Management to strengthen UM processes, and tracks denial trends to help the team adapt to evolving payor challenges.

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 Functions

• Status determinations for hospitalized patients
• Perform peer to peers with payors’ medical directors
• Short inpatient stay reviews
• Review observation patients daily
• Build relationship with medical staff and leadership to get their buy-in with UM issues
• Attend UM Committees as subject matter expert
• Assist with denials and appeals as appropriate
• Educate medical staff on UM topics
• Partner with UR nurses, IA staff, and Case Management to maintain and improve upon the UM process
• Track denial trends to assist the team evolve to meet new payor challenges

Employment Qualifications: MD/DO Physician

- Demonstrated advanced usage of AI, success in translating AI into Business outcomes, and the ability to move teams from experimentation to scale.

- This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

This position pays between $198,000- $297,000 based on relevant experience.

Join an award-winning company

Five-time winner of “Best in KLAS” 2020-2022, 2024-2025

Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024

22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024

Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024

Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023

Energage Top Workplaces USA 2022-2024

Fortune Media Best Workplaces in Healthcare 2024

Monster Top Workplace for Remote Work 2024

Great Place to Work certified 2023-2024

• Innovation
• Work-Life Flexibility
• Leadership
• Purpose + Values

Bottom 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 your 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].

This 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