- Provider Solutions & Development (Mission Hills, CA)
- Providence Holy Cross Medical Center is seeking a Physician Advisor / UM Medical Director to join a strong leadership team promoting high-value care in ... develop strong collaborative and positive mutually supported relationships between the medical center and its physicians to improve clinical quality, resource… more
- Sutter Health (Oakland, CA)
- …Health Internal Physician Advisor Services (IPAS). The physician Advisor will work closely with the medical staff, including house staff, and all ... Health! **Organization:** SHSO-Sutter Health System Office-Bay **Position Overview:** The Physician Advisor (PA) is a key member...UM staff and health care team members and medical directors of third-party payers to discuss the needs… more
- Catholic Health Initiatives (Bismarck, ND)
- **Job Summary and Responsibilities** **Join Our Team as a Physician Advisor at CHI St. Alexius Health!** Are you a physician leader passionate about ... compliance, and driving clinical excellence? CHI St. Alexius Health is seeking a visionary ** Physician Advisor ** to join our dedicated team and make a profound… more
- CommonSpirit Health (Salt Lake City, UT)
- …in or willing to relocate to the Salt Lake City Area._ The Physician Advisor reports directly to the Medical Director Physician Advisor /UR and ... is responsible for maintaining a collaborative partnership with the Medical Director CDI, Enterprise Director Case Management, UM...Committees or administrative roles, preferred. + Experience as a Physician Advisor in the acute care setting… more
- MaineGeneral Health (Augusta, ME)
- …is seeking an experienced physician , (MD or DO) for the role of Physician Advisor . In this role, the individual will: + Provide clinical leadership and ... Medical Center has an internal referral bonus program for all employed medical staff. Please contact physician recruitment for more details of this program.… more
- CommonSpirit Health (Phoenix, AZ)
- …of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty Certification by the American Board of ... federal, state and payer regulatory and contract requirements. + Previous Physician Advisor /Care Management or equivalent experience. Excellent communication… more
- CVS Health (Madison, WI)
- …Michigan and Oklahoma. Support for other regions may occasionally be required. The UM Medical Director will ensure timely and consistent responses to members ... supports the Aetna Better Health Plan of Oklahoma. This UM (Utilization Management) Medical Director will be...at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent… more
- LA Care Health Plan (Los Angeles, CA)
- …member/family interaction to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for ... cases and reports are maintained and referred to the Physician Advisor / UM Director. Document in...or HMO setting . Preferred: Managed Care experience performing UM and CM at a medical group… more
- Humana (Richmond, VA)
- …between Humana and its partners. **Required Qualifications** + A current and unrestricted medical Physician (MD/DO) license in at least one jurisdiction. + ... community and help us put health first** The Chief Medical Officer (CMO), Group Medicare leads and is accountable...exceeds outcomes related but not limited to trend, pharmacy, UM , clinical performance, risk adjustment, and stars. This CMO… more
- Community Health Systems (Bentonville, AR)
- … necessity, and utilization of hospital services, escalating cases as needed to the Physician Advisor or Utilization Management ( UM ) committee. + Identifies ... patient care activities under the supervision of a Registered Nurse or physician . This role involves reviewing medical records for appropriateness and… more
- Community Health Systems (Siloam Springs, AR)
- … necessity, and utilization of hospital services, escalating cases as needed to the Physician Advisor or Utilization Management ( UM ) committee. + Identifies ... patient care activities under the supervision of a Registered Nurse or physician . This role involves reviewing medical records for appropriateness and… more
- Eastern Connecticut Health Network (Manchester, CT)
- …and regulations for continued stay. + Escalates review timely to physician advisor timely for lack of medical necessity and/or status discrepancies. + ... and documents findings based on department policy/procedure; refers appropriate cases to Physician Advisor for recommendation(s). + Ensures order in chart/EMR… more
- Huron Consulting Group (Chicago, IL)
- …escalating cases as necessary to payers, physician advisors, leadership, or the medical team. + Physician Advisor Relationship: Works closely with ... internal processes and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and… more
- Nuvance Health (Danbury, CT)
- …prioritize improvement efforts, and negotiate with payers for fair reimbursement. * * Physician Advisor Collaboration:* Collaborate with the physician ... committee to ensure CMS and regulatory compliance.* *Develop and maintain a UM plan to guide the team with detailed processes and procedures. Attend… more
- Tenet Healthcare (Detroit, MI)
- …Performing accurate medical necessity screening and timely submission for Physician Advisor reviews Collaborating with payors, physicians, office staff and ... an authorization process Closes open cases on the incomplete UM Census Completes the Medicare Certification Checklist on applicable...the appropriate status and level of care based on Medical Necessity and submits case for Secondary Physician… more