Physician Advisor - Onsite - Latrobe PA - No nights/overnights or weekends!

Optum; Latrobe (Westmoreland County); On-site; USD 124,000 - 240,000; Full time

Job summary

Optum seeks a Physician Advisor to enhance healthcare delivery through collaboration with hospital staff. This non-clinical role involves conducting medical necessity reviews and optimizing service utilization. Candidates should have an MD or DO, a medical license, and experience in hospital settings. Competitive salary and comprehensive benefits are offered.

Benefits

Comprehensive benefits package

Incentives

Stock purchase

401k

Qualifications

• 3+ years hospital-based practice experience.
• Experience with medical staff and hospital leadership rapport.
• Experience working with administrative, clinical, and leadership teams.

Responsibilities

• Conduct second-level medical necessity and compliance status reviews.
• Advise medical staff on documentation and medical necessity decisions.
• Participate in the claims denial process through peer-to-peer discussions.

Skills

Medical necessity

Documentation

Utilization management

Collaboration

Computer skills

Education

MD or DO

Current, unrestricted medical license in Maine

Tools

EMR

Job description

Description -

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Join us to start Caring. Connecting. Growing together.

This position is for qualified physicians seeking to enter the new and growing non-clinical practice specialty of Physician Advisor within a facility setting. The Physician Advisor will drive performance by communicating with hospital physicians and utilization management staff at client hospitals to promote best practices for evidence-based care and documentation. The role involves establishing, maintaining, and strengthening relationships with Optum client hospitals to optimize the use of Optum services.

Training will be provided by Optum. The Physician Advisor will join a team of advisors across the country. Although employed by Optum, the PA will become a key member of the client hospital's team, focusing on effective, efficient utilization of healthcare services. The PA will develop expertise in medical necessity, documentation, and payor interactions. The role requires onsite work at the facility during standard business hours, Monday through Friday.

The Physician Advisor will collaborate with medical staff and hospital leadership on medical necessity and denial reviews. All Physician Advisors have a shared, minimum holiday coverage requirement, which is covered remotely.

Primary Responsibilities:

1. Conduct second-level medical necessity and compliance status reviews for all payor types.
2. Gain and maintain knowledge of technical systems for case reviews.
3. Meet with case management, utilization management, social work, and healthcare team members to discuss cases and make recommendations.
4. Interact with medical staff regarding medical necessity and denial cases.
5. Advise medical staff on documentation and medical necessity decisions.
6. Participate in the claims denial process through peer-to-peer discussions with payor medical directors.
7. Coordinate with Subject Matter Experts on regulatory requirements.
8. Serve as a member of the Utilization Review Committee, possibly requiring non-clinical privileges.
9. Provide education on utilization management topics to medical and UM staff.
10. Develop knowledge of OPAS guidance on diagnoses and disease states; training provided.

What the Physician Advisor Will Not:

• Practice medicine during scheduled hours or make clinical decisions about patient care.
• Write orders or prescriptions.
• Provide on-call coverage.
• Set hospital policies or supervise staff.
• Participate in peer review or clinical research.
• Make medical decisions for patient treatment.
• Distribute proprietary guidance without authorization.
• Execute contracts or post opinions publicly without approval.

Performance will be recognized and rewarded, with clear pathways for success and development opportunities.

Qualifications -

Required Qualifications:

• MD or DO
• Current, unrestricted medical license in Maine
• 3+ years hospital-based practice experience
• Experience with medical staff and hospital leadership rapport
• Experience working with administrative, clinical, and leadership teams
• Solid computer skills and EMR knowledge

Preferred Qualifications:

• Board certification or eligibility
• Experience as a Physician Advisor or in Utilization Review

The salary range is $124,500 - $239,500 annually, based on full-time employment, experience, and achievement metrics. Benefits include a comprehensive package, incentives, stock purchase, and 401k. We are committed to diversity, equity, and inclusion, addressing health disparities, and providing equitable care. UnitedHealth Group is an Equal Opportunity Employer and a drug-free workplace, requiring a drug test before employment.