- Houston Methodist (Houston, TX)
- At Houston Methodist, the Physician Advisor is responsible for teaching, consulting, and advising the case management department, clinical documentation ... of healthcare quality and acceptable levels of cost. The Physician Advisor will conduct clinical reviews on...management . + Actively participate in the hospital's claim denial process, including, but not limited to, responding to… more
- WellSpan Health (York, PA)
- Physician Advisor Location: WellSpan Medical Group, York, PA Schedule: PRN/Per Diem General Summary Provides direct supervision of case management and ... and Federal regulations and coordinates resolution between the treating physician and health plan medical management services....to Health referrals and cases as needed. + Provides Physician Advisor support to all WellSpan entities… more
- Sutter Health (San Francisco, CA)
- **Organization:** SHSO-Sutter Health System Office-Bay **Position Overview:** The Physician Advisor (PA) is a key member of the hospital's leadership team ... resources, medical necessity, documentation best practices, level of care progression, denial management and compliance with governmental regulations and… more
- Novant Health (Winston Salem, NC)
- **Overview** Novant Health is looking for a System Physician Advisor to join their Safety & Quality Institute. This role is charged with meeting the ... for assuring the effective, efficient utilization of health care services. The Physician Advisor will have the responsibility of improving care delivered… more
- Ascension Health (Milwaukee, WI)
- **Details** + **Specialty:** Physician , Physician Advisor + **Department:** Administation, Physician Advisor + **Schedule:** Full-time + ... level of care and length of stay determination. + Assist and manage the denial management process. Review and offer suggestions related to resources and service… more
- Ascension Health (Austin, TX)
- **Details** + **Postition:** Physician Advisor -Pediatrics + **Schedule:** Full-time + **Hospital:** Ascension Seton + **Location:** Austin, TX **Benefits** Paid ... seeks a Board-certified Pediatrician to serve as a full-time Physician Advisor . In this role, the candidate...length of stay determination. + Assist and manage the denial management process. Review and offer suggestions… more
- US Tech Solutions (May, OK)
- …health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (20%) + Reviews cases in progress ... **Job Description:** + As an RPh Advisor you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You… more
- SSM Health (Oklahoma City, OK)
- …and integrated networks. + Acts as primary contact for regional leadership with physician advisor services through oversight of vendor services to improve our ... their respective region. + Accountable to the regional leadership team for denial management , medical necessity, and appropriate utilization of inpatient… more
- Arnot Health (Elmira, NY)
- …of auth/ denial review decisions. 8. Maintains a working relationship with Physician Advisor regarding physician issues related to auths/denials. 9. ... as needed. 10. Maintains a working knowledge of programs necessary for denial management (ie: excel, word, QCPR, Sorian, InterQual, eCW) 11. Maintains files and… more
- Stanford Health Care (Palo Alto, CA)
- …with physician advisors to ensure clinically sound and persuasive appeals. 5. Physician Advisor Collaboration: Engage with physician advisors on a ... with regulatory standards and achieve organizational goals. + Consult with the Physician Advisor to discuss complex cases, medical necessity, and strategies… more
- Billings Clinic (Billings, MT)
- …to provide additional clinical information supporting status or LOC, escalate case to the physician advisor for second level review as early as possible and ... Medicare (IMM). Follows department procedures and policies for Condition Code44, Physician Advisor review, and HINN processes Documents Avoidable Days/Delays,… more
- UPMC (Mechanicsburg, PA)
- …+ Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor , Attending Physicians and clinical team to ... LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation… more
- UPMC (Harrisburg, PA)
- …+ Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor , Attending Physicians and clinical team to ... LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation… more
- UPMC (Carlisle, PA)
- …+ Takes leadership role in concurrent denial process. Works with Care Management Director, Physician Advisor , Attending Physicians and clinical team to ... LOC requirements and that chart documentation supports LOC determination. Works with Physician Advisor and Attending Physicians to obtain necessary documentation… more
- LA Care Health Plan (Los Angeles, CA)
- …and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and ... Utilization Management Nurse Specialist LVN II Job Category: Clinical...times specific to the case type. Identifies cases needing Physician Advisor (PA) review or input and… more
- AdventHealth (Maitland, FL)
- …**Days - This is On Site position** **The role you'll contribute:** As the physician advisor , the Executive Medical Director of Revenue Cycle educates, informs, ... care payers. The Medical Director is responsible for providing physician review of utilization, claims management , and... . Two years or greater experience as a Physician Advisor **LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED**… more
- LifePoint Health (Brentwood, TN)
- …high quality, timely, and effectively written appeals. . Engage and consult with Physician Advisor and/or CMO to resolve provider issues regarding answering ... for providing CDI program oversight and day-to-day implementation and management of processes related to the concurrent review of...taken within appeal time frames to address DRG downgrade denial . . Serve as subject matter expert on … more
- AdventHealth (Tavares, FL)
- …hospital staff, and community agencies/liaisons. + Coordinate authorization/ denial management communications with physician advisor , PFS, revenue ... coordinating clinical requests for payers and assisting in the authorizations and denial management communication between Case Management and PFS. The CMA… more
- Bon Secours Mercy Health (Mason, OH)
- …Fosters integration and strong collaborative partnerships with nursing, quality, hospitalist, physician advisor , other physician leadership in supporting ... and staff to ensure seamless transitions of care. + Partners with physician leader to optimize the Utilization Management Committee, providing actionable… more
- LA Care Health Plan (Los Angeles, CA)
- …and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service and ... Utilization Management Nurse Specialist RN II Job Category: Clinical...cases and reports are maintained and referred to the Physician Advisor /UM Director. Document in platform/system of… more