Remote Physician Advisor - Utilization & UM Expert

Ensemble Health Partners

Oregon

Hybrid

USD 198,000 - 297,000

Full time

10 days ago

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Benefits offered by this job

Healthcare

Time off

Retirement plan

Well-being programs

Tuition reimbursement

Certification/education support

Job summary

Ensemble Health Partners is seeking a Physician Advisor to render compliant status determinations for hospitalized patients and conduct peer-to-peer reviews with payors' medical directors. You will serve as a UM subject matter expert, review short inpatient stays, and engage with medical staff to support UM initiatives.

In addition, you will attend UM committees, assist with denials and appeals, and educate clinical teams on UM topics while partnering with UR nurses and Case Management to

Qualifications

MD/DO physician with demonstrated advanced usage of AI and ability to translate AI into business outcomes.
Willingness to travel to client sites or corporate locations as business needs require.

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 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 UM processes
Track denial trends to assist the team evolve to meet new payor challenges

Skills

AI in healthcare

AI to business outcomes

Scale-up leadership

Education

MD/DO Physician

Job description

In addition, you will attend UM committees, assist with denials and appeals, and educate clinical teams on UM topics while partnering with UR nurses and Case Management to

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