Physician Advisor - Utilization & Care Optimization

Med-Metrix; United States; A distancia; USD 150.000 - 230.000; Jornada completa

Descripción de la vacante

Med-Metrix is seeking a Physician Advisor to perform comprehensive case reviews to ensure medical necessity, optimize hospital resource use, and improve documentation and coding across patient care levels.

The role requires board certification and an active US license, with 3+ years in physician advisory duties, strong UM knowledge, and excellent communication. Expect collaboration with medical staff leadership and participation in governance and peer reviews.

Formación

• Board Certified and licensed to practice medicine in the US or 3+ years active clinical experience in the US.
• 3+ years working as a Physician Advisor performing Level of care reviews and Peer to Peer Reviews.
• Basic technical skills with Hospital EMRs a must.

Responsabilidades

• Responds to requests for clinical reviews for medical necessity or other reasons by the Case Management department in a timely fashion.
• Provides consultation to attendings, nurses, and case management staff on complex clinical issues and justifications for continued stay, medical necessity, and utilization management.
• Applies standard criteria such as MCG/InterQual with professional judgment and patient-specific variables.
• Maintains accountability for achieving case management outcomes and supports medical staff in clinical progression of patient care.
• Describes improvements to health-record documentation affecting ICD code assignment and DRG capture.
• Participates in ongoing training related to Utilization Management and Care Management.
• Meets productivity and quality standards within established time requirements.
• Demonstrates commitment to organizational strategic initiatives and values of teamwork.
• Mentors physicians regarding payer requirements and participates in peer reviews as requested.
• Maintains medical licensure and board certification in good standing.

Conocimientos

Board Certified

US Medical License

Physician Advisor experience

InterQual/MCG knowledge

Microsoft Office

Communication skills

Educación

MD/DO degree

Residency completed

Herramientas

EMR systems

Microsoft Office

Descripción del empleo

Med-Metrix is seeking a Physician Advisor to perform comprehensive case reviews to ensure medical necessity, optimize hospital resource use, and improve documentation and coding across patient care levels.

The role requires board certification and an active US license, with 3+ years in physician advisory duties, strong UM knowledge, and excellent communication. Expect collaboration with medical staff leadership and participation in governance and peer reviews.