Remote Physician Advisor: Utilization Management Leader

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

Job summary

Ensemble RCM is seeking a Physician Advisor in the United States to render compliant status determinations for hospitalized patients and perform peer reviews with payors' medical directors. You will lead utilization management initiatives, educate staff, and attend UM committees to support denials and appeals.

The role emphasizes building strong relationships with medical staff and leadership to gain buy-in for UM initiatives. Travel to client sites may be required.

Qualifications

• Advanced usage of AI with demonstrated ability to translate AI into business outcomes.
• Willingness to travel and work onsite at client, temporary, or corporate locations as required.

Responsibilities

• Status determinations for hospitalized patients
• Perform peer to peers with payors' medical directors
• Short inpatient stay reviews
• Review observation patients daily
• Build relationship with medical staff and leadership to get their buy-in with 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 maintain and improve upon the UM process
• Track denial trends to assist the team evolve to meet new payor challenges

Skills

Leadership Decision Making

Coaching & Building Talent

Delegation

Leading Teams

Executive Communication

Program/Project Management

Education

MD/DO Physician

Job description

Ensemble RCM is seeking a Physician Advisor in the United States to render compliant status determinations for hospitalized patients and perform peer reviews with payors' medical directors. You will lead utilization management initiatives, educate staff, and attend UM committees to support denials and appeals.

The role emphasizes building strong relationships with medical staff and leadership to gain buy-in for UM initiatives. Travel to client sites may be required.