Remote Physician Advisor - Utilization Management Expert

Ensemble Health Partners; Ohio; Remote; USD 198,000 - 297,000; Full time

Job summary

Ensemble Health Partners is seeking a Physician Advisor to render compliant statuses for hospitalized patients, perform peer reviews with payors, and act as a UM expert. The role emphasizes collaboration with medical staff, attending UM committees, and guiding denials and appeals.

Remote position with occasional onsite travel; requires MD/DO and ability to translate AI insights into improved business outcomes within healthcare revenue cycle management.

Qualifications

• MD/DO physician with demonstrated AI expertise translating AI insights into business outcomes.
• Ability to work remotely and travel to client sites as needed.

Responsibilities

• Render compliant status determinations for hospitalized patients.
• Conduct peer-to-peer reviews with payors' medical directors.
• Serve as subject matter expert on utilization management (UM) issues.
• Review short inpatient stays and observation patients daily.
• Collaborate with medical staff and leadership to gain buy-in for UM initiatives.
• Attend UM committees and assist with denials/appeals.
• Educate medical staff on UM topics.
• Partner with UR nurses, IA staff, and Case Management to improve UM processes.
• Track denial trends to adapt to payor challenges.

Skills

MD/DO Physician

AI in business outcomes

Education

MD/DO

Job description

Ensemble Health Partners is seeking a Physician Advisor to render compliant statuses for hospitalized patients, perform peer reviews with payors, and act as a UM expert. The role emphasizes collaboration with medical staff, attending UM committees, and guiding denials and appeals.

Remote position with occasional onsite travel; requires MD/DO and ability to translate AI insights into improved business outcomes within healthcare revenue cycle management.