Physician Utilization & Case Management Advisor

Long Tail Health Solutions; Long Beach (CA); On-site; USD 250,000 - 320,000; Full time

Job summary

Long Tail Health Solutions in California seeks a Physician Advisor to support utilization management, case management, revenue cycle and clinical documentation improvement. You will review medical necessity, support various statuses, and provide physician-to-physician consultation to ensure compliant care.

The role involves payer peer reviews, complex case escalation, discharge barrier handling, and engagement with physicians to educate on CMS requirements.

Qualifications

• Doctorate from an accredited Medical or Osteopathic School.
• At least 3 years of clinical practice experience.
• Prior experience in physician advisory OR certification as a physician advisor.
• Board certification in applicable specialty and active privileges within 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 CMS/payor requirements
• Other duties as assigned

Skills

Clinical practice experience

Physician advisor experience

Education

Doctorate from an accredited Medical or Osteopathic School

Board Certified in applicable specialty

Active medical staff privileges within 90 days of hire

Job description

Long Tail Health Solutions in California seeks a Physician Advisor to support utilization management, case management, revenue cycle and clinical documentation improvement. You will review medical necessity, support various statuses, and provide physician-to-physician consultation to ensure compliant care.

The role involves payer peer reviews, complex case escalation, discharge barrier handling, and engagement with physicians to educate on CMS requirements.