Physician Advisor
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About The Position
As a Physician Advisor at R1 RCM, you will play a crucial role in helping client facilities navigate the complexities of compliant revenue management. Your primary responsibility will involve reviewing payor peer-to-peer cases, particularly focusing on cases where authorization has been denied. You will evaluate whether the necessary documentation was available for the admission status, procedure, and care setting that was requested. This position requires you to provide expert advice to clients regarding the appropriateness of requests based on the available documentation, and you will also engage in discussions with medical directors from the payor side to advocate for the cases you review. In this role, you will address various issues including the authorization requested, the documentation support or lack thereof for that authorization, and the evidence-based criteria that support the request. You will be expected to conduct complex clinical evaluations of the requests as a whole, ensuring that all aspects are thoroughly considered. Timeliness is key, as you will need to review and respond to both payors and customers promptly. Your active engagement with payor medical directors will be essential in discussing the appropriate authorization status as supported by the documentation provided. Additionally, you will be responsible for providing written analyses of cases and performing case reviews across multiple specialties. As a clinical resource, you will assist medical and case management staff by identifying, facilitating, and resolving documentation and utilization issues. This position demands strong clinical knowledge across various areas and the ability to work independently while maintaining a high level of performance in a fast-paced and rapidly changing environment. Proficiency in basic computer skills is also essential for success in this remote position.
