Physician Advisor: Utilization & Care Optimization Leader

ensemblehp; United States; Remote; USD 198,000 - 297,000; Full time

Job summary

Ensemble is seeking a Physician Advisor to lead utilization management initiatives across hospital systems and physician groups. The role involves collaborating with medical staff leadership to optimize resource use, ensure appropriate levels of care, and support documentation and coding improvements.

Responsibilities include peer-to-peer reviews, observation reviews, committee participation, and education of medical staff on UM topics.

Qualifications

• MD/DO Physician required.
• Demonstrated leadership in medical staff settings.
• Experience with utilization management and peer reviews preferred.

Responsibilities

• Status determinations for hospitalized patients.
• Peer-to-peer reviews with payors' medical directors.
• Short inpatient stay reviews.
• Review observation patients daily.
• Build relationships with medical staff and leadership to gain buy-in on 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 improve UM process.
• Track denial trends to help the team adapt to payor challenges.

Skills

Leadership

Coaching & Building Talent

Delegation

Leading Teams

Executive Communication

Program/Project Management

Education

MD/DO Physician

Job description

Ensemble is seeking a Physician Advisor to lead utilization management initiatives across hospital systems and physician groups. The role involves collaborating with medical staff leadership to optimize resource use, ensure appropriate levels of care, and support documentation and coding improvements.

Responsibilities include peer-to-peer reviews, observation reviews, committee participation, and education of medical staff on UM topics.