Physician Advisor – Utilization & Case Management

Long Tail; Long Beach (CA); On-site; USD 180,000 - 250,000; Full time

Job summary

Long Tail Health Solutions Inc. is seeking a Physician Advisor to support utilization management, case management, revenue cycle, clinical documentation improvement, and related clinical operations in a health system setting.

You will perform medical necessity and patient status reviews, advise on inpatient/outpatient/observation status, and collaborate with physicians and payers to address CMS and payer requirements.

Qualifications

• Doctorate from an accredited Medical or Osteopathic School.
• 3 years of experience in a clinical practice.
• Experience in physician advisory OR certification as a physician advisor.
• Board Certified in applicable specialty.
• Active medical staff privileges obtained within ninety (90) days of hire.

Responsibilities

• medical necessity and patient status review;
• inpatient, outpatient, and observation status support;
• physician-to-physician consultation;
• payer peer-to-peer reviews and appeals;
• complex case and discharge barrier escalation including MDRs;
• post-acute care appeals;
• length-of-stay and readmission management support;
• physician engagement and education regarding utilization management, documentation, and applicable CMS and payer requirements.
• Other duties as assigned

Skills

Medical knowledge

Clinical judgment

Communication with physicians

Payer policy understanding

Education

MD/DO Doctorate

Board Certification

Job description

Long Tail Health Solutions Inc. is seeking a Physician Advisor to support utilization management, case management, revenue cycle, clinical documentation improvement, and related clinical operations in a health system setting.

You will perform medical necessity and patient status reviews, advise on inpatient/outpatient/observation status, and collaborate with physicians and payers to address CMS and payer requirements.