Physician Advisor - Remote

Med Metrix•Chicago, IL

20d•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 works with physician advisory, hospital, care coordination, utilization management, and case management teams to support sound clinical decisions and appropriate documentation. It also helps maintain compliance with applicable legal, regulatory, accreditation, and payer requirements, and with the organization’s privacy and information-security policies. The position is remote. The employee must have a smartphone or other electronic device capable of downloading applications for multifactor authentication and security purposes. The work environment is usually quiet. The role involves occasional movement around the work area and use of computers, telephones, and other office equipment, as well as the ability to follow directions, collaborate, and handle stress.

Requirements

MD or DO with an active, unrestricted medical license.
Board certification in a recognized specialty in the United States.
At least 1 year of payor-side or provider-side utilization review experience, or active ACPA and/or ABQUARP certification.
Basic technical skills with hospital electronic medical records.
Strong knowledge of utilization management, medical necessity, and payer regulations.
Ability to present information effectively in formal and informal settings.
Proficiency in Microsoft Office Suite.
Strong interpersonal skills and ability to communicate well at all organizational levels.
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.
Smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes.
Ability to follow directions, collaborate with others, and handle stress.

Nice To Haves

Familiarity with MCG or 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 best practices.
Help improve documentation related to ICD coding, severity of illness, risk of mortality, and DRG assignment.
Stay current with CMS and MCG evidence-based guidelines to support utilization management decisions.
Maintain compliance with legal, regulatory, and accreditation requirements and payer-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 protected health information to the minimum necessary for assigned duties.