Physician Advisor: Utilization & Care Management Leader

Ensemble Health Partners; Florida; Hybrid; USD 198,000 - 297,000; Full time

Benefits offered by this job

Healthcare benefits

Time off

Retirement plan

Well-being programs

Tuition reimbursement

Certification support

Job summary

Ensemble Health Partners is seeking a Physician Advisor to lead utilization management, collaborating with medical staff leadership to optimize resource use and ensure appropriate levels of care. The role involves education, policy development, and communication with boards and committees to improve outcomes.

The position emphasizes accountable decision-making, cross-functional collaboration, and oversight of peer-to-peer reviews, with a strong focus on cost-effective, high-quality patient care

Qualifications

• MD/DO Physician (MUST have)

Responsibilities

• 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

Education

MD/DO Physician (MUST have)

Job description

Ensemble Health Partners is seeking a Physician Advisor to lead utilization management, collaborating with medical staff leadership to optimize resource use and ensure appropriate levels of care. The role involves education, policy development, and communication with boards and committees to improve outcomes.

The position emphasizes accountable decision-making, cross-functional collaboration, and oversight of peer-to-peer reviews, with a strong focus on cost-effective, high-quality patient care