Careers

Start the day excited to make a difference...end the day knowing you did. Come join our team.

Experienced physician seeking a non-clinical practice specialty of Physician Advisor. In this role, you will drive performance across our organization by communicating with hospital physicians, care coordination and utilization management staff to champion best practices for evidence-based care and its documentation. You will develop expertise and provide valuable guidance on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial management, and compliance with governmental regulations. You will become a key member of the team charged with meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. This includes care management processes that ensure patients are in the appropriate level of care with supporting documentation for regulatory compliance and accurate coding. Along with employing your clinical and administrative skills, you are also an educator. Paramount to being successful and effective in this role, one must possess and display superior interpersonal skills.

Primary Responsibilities:

• Conduct medical necessity reviews of cases referred by care coordination to ensure medical necessity and regulatory requirements are met for level of care
• Meet with care coordination, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status
• Interact with medical staff and medical directors of third-party payers to discuss the needs of patients and alternative levels of care
• Act as a consultant for the medical staff regarding their decisions for the appropriate level of care of hospitalized patients and supporting documentation
• Review of utilization data to ensure hospital objectives for quality patient care
• Act as a resource for the medical staff regarding federal, state, and payer regulatory, quality, and contract requirements
• Serve as a physician member of the Utilization Review Committee
• Provide education on utilization management topics (e.g., documentation) to the medical and UM staffs

REQUIRED EXPERIENCE:

• Medical Degree MD or DO
• BC Internal Medicine, Family Medicine or Emergency Medicine
• Virginia Licensed Physician or eligible
• Demonstrated ability to build rapport with medical staff and hospital leadership
• Experience practicing medicine, preferably as an Adult Hospitalist or an ED Physician.
• Strong Documentation and Coding standards
• Strong Interpersonal skills
• Ability to build strong relationships.
• Diplomatic, Negotiation and peace keeping skills.

PREFERRED EXPERIENCE:

• Previous experience as a Physician Advisor
• Experience with and/or strong understanding of medical necessity criteria (e.g. MCG, InterQual, etc.)

As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.