Physician Advisor - Inpatient Utilization & Denials

Trinity Health; Des Moines (IA); On-site; USD 180,000 - 240,000; Full time

Benefits offered by this job

Paid malpractice

403B match

Job summary

MercyOne Central Iowa is seeking a board-certified physician with inpatient experience to serve as Physician Advisor. The role focuses on clinical resource utilization, determining medical necessity, and guiding colleagues through CMS and insurance guidelines.

The onsite position involves collaborating with MercyOne Leadership and hospital teams to design interventions, uphold peer-to-peer processes, and improve care decisions within a large Catholic health system in Iowa.

Qualifications

• Board-certified physician with inpatient experience.
• Strong knowledge of CMS and commercial insurance regulations.
• Experience serving on hospital committees or governance bodies.

Responsibilities

• Lead physician-driven clinical resource utilization program and work with MercyOne Leadership team to design interventions when necessary.
• Review cases to determine appropriate level of care based on medical necessity, and apply regulatory, health plan, and clinical guidelines in the review of denials.
• Serve as a resource for physicians regarding medical necessity, level of care, and clinical documentation.
• Foster effective communication between members of the care team.
• Establish and maintain peer-to-peer protocol.
• Establish peer-to-peer protocol

Skills

Board-certified Physician

Inpatient experience

CMS regulations knowledge

Team-building mindset

Collaborative decision making

Education

MD/DO

Tools

Regulatory compliance tools

Job description

MercyOne Central Iowa is seeking a board-certified physician with inpatient experience to serve as Physician Advisor. The role focuses on clinical resource utilization, determining medical necessity, and guiding colleagues through CMS and insurance guidelines.

The onsite position involves collaborating with MercyOne Leadership and hospital teams to design interventions, uphold peer-to-peer processes, and improve care decisions within a large Catholic health system in Iowa.