Physician Advisor - Remote

Med-Metrix•Chicago, IL

21d•Remote

About The Position

The Physician Advisor provides physician-to-physician reviews, clinical guidance, education, and escalation support while promoting evidence-based practices and appropriate resource utilization. The role supports utilization review and case management teams with complex clinical decisions, encourages best practices in care and documentation, and helps improve documentation related to ICD coding, severity of illness, risk of mortality, and DRG assignment. The Physician Advisor keeps current with CMS and MCG evidence-based guidelines and complies with legal, regulatory, accreditation, and payor partner requirements. The position also requires meeting established productivity and quality standards, attending required training and meetings, participating in peer review as needed, and performing other assigned duties. Patient protected health information must be used, protected, and disclosed in accordance with HIPAA and information-security policies, with access limited to the minimum necessary.

Requirements

MD or DO with an active, unrestricted medical license.
US board certification in a recognized specialty.
At least one year of payor- or provider-side utilization review experience, or active ACPA and/or ABQUARP certification.
Basic technical skills with hospital EMRs.
Strong knowledge of utilization management, medical necessity, and payer regulations.
Ability to present information effectively, both formally and informally.
Proficiency in Microsoft Office Suite.
Strong interpersonal skills and ability to communicate effectively at all levels of the organization.
Strong problem-solving and creative skills, sound judgment, and ability to make decisions based on accurate and timely analyses.
High integrity and dependability, a strong sense of urgency, and a results-oriented approach.
Excellent written and verbal communication skills.
Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.

Nice To Haves

Familiarity with MCG/InterQual placement status criteria.
Membership in the American College of Physician Advisors (ACPA).

Responsibilities

Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention or appeals.
Support utilization review and case management teams with complex clinical decision-making.
Communicate with the Physician Advisory team, hospital physicians, care coordination, and utilization management staff to encourage evidence-based care and documentation practices.
Assist in improving documentation related to ICD coding, severity of illness, risk of mortality, and DRG assignment.
Keep abreast of current CMS and MCG evidence-based guidelines to support utilization management decisions.
Maintain compliance with legal, regulatory, and accreditation requirements and payor partner policies.
Meet productivity and quality standards within established time requirements.
Attend required training and meetings.
Participate in the peer review process as needed.
Perform other duties as assigned.
Use, protect, and disclose patients’ protected health information only in accordance with HIPAA standards.
Comply with Information Security and HIPAA policies and procedures and limit access to PHI to the minimum necessary.