Physician Advisor Lead
New
J
JobgetherHealthcare utilization management
Based in the United StatesFull-TimeLead
Salary not disclosed
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Job Details
- Experience
- Significant experience as a Physician Advisor
- Required Skills
- EHR
Requirements
- Hold an active, unrestricted physician license in the United States.
- Have board certification in an appropriate medical specialty.
- Have significant experience as a Physician Advisor, including maintaining an active clinical production workload alongside leadership and quality oversight.
- Bring a strong background in utilization management, hospital medicine, healthcare revenue cycle management, or a related clinical setting.
- Demonstrate expertise in peer-to-peer reviews, medical necessity determinations, inpatient admission criteria, continued stay reviews, denials, appeals, and payer processes.
- Have experience evaluating complex clinical cases and conducting payer-to-provider discussions and negotiations.
- Have experience coaching, mentoring, or leading physicians preferred.
- Be able to evaluate performance metrics, conduct quality audits, identify trends, and turn findings into improvement initiatives.
- Have strong written and verbal communication, negotiation, interpersonal, and problem-solving skills.
- Be familiar with Epic or another major electronic health record platform preferred.
- Be able to work independently in a remote, client-facing environment while meeting clinical production, leadership, quality, timeliness, and service expectations.
- Have strong organizational skills, sound clinical judgment, and the ability to manage competing priorities.
- Be willing to travel as needed.
Responsibilities
- Provide day-to-day clinical leadership and mentorship to Physician Advisors while maintaining an active production workload.
- Serve as a senior clinical expert for complex and escalated utilization review, medical necessity, and peer-to-peer cases.
- Establish standards for clinical decision-making, documentation, communication, and client service.
- Conduct and oversee quality reviews and call audits.
- Monitor performance indicators, including peer-to-peer completion, responsiveness, overturn rates, quality, timeliness, and client satisfaction.
- Analyze performance trends and identify coaching, education, workflow, and quality improvement opportunities.
- Support onboarding, training, and continuing professional development for Physician Advisors.
- Develop educational resources and standardized best practices for peer-to-peer preparation, documentation, escalation, follow-up, and payer communication.
- Advise clients on escalated clinical and operational issues and participate in client meetings and reviews.
- Partner with leadership to improve workflows and develop clinical recommendations and specialized Physician Advisor programs.
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