Physician Advisor - Utilization Management & Revenue Cycle

lths-main; Long Beach (CA); On-site; USD 200,000 - 280,000; Full time

Job summary

Long Tail Health Solutions Inc. is seeking a Physician Advisor to support utilization management, case management, and related clinical operations across a health system. You will review medical necessity, patient status, and engage in physician-to-physician consultations with payer peers.

Responsibilities include managing inpatient/outpatient status, MDRs, discharge barriers, and post-acute appeals, while educating clinicians on CMS and payer requirements.

Qualifications

• Doctorate from an accredited Medical or Osteopathic School.
• 3 years of experience in a clinical practice.
• Certification as a physician advisor or equivalent experience.

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 and CMS/payer requirements.
• Other duties as assigned

Education

Doctorate from an accredited Medical or Osteopathic School

Board Certified in applicable specialty

Job description

Long Tail Health Solutions Inc. is seeking a Physician Advisor to support utilization management, case management, and related clinical operations across a health system. You will review medical necessity, patient status, and engage in physician-to-physician consultations with payer peers.

Responsibilities include managing inpatient/outpatient status, MDRs, discharge barriers, and post-acute appeals, while educating clinicians on CMS and payer requirements.