Physician Advisor - Concurrent Appeals & Denials - Remote

UnitedHealth Group•Newtown Square, PA

21d•$160,000 - $300,000•Remote

About The Position

Optum Insight is hiring a remote Physician Advisor to provide medical necessity and compliance reviews for client hospitals. The role partners with providers, case managers, and payors to conduct concurrent reviews, facilitate peer-to-peer discussions, manage written and verbal appeals, and support appropriate patient-status determinations. The Physician Advisor helps promote timely, evidence-based, cost-effective care and compliance with regulatory requirements and CMS policy concerning inpatient admissions, observation/outpatient status, and continued hospital stays. The position works as part of a team that includes other Physician Advisors, nurses, administrative assistants, clinical relationship managers, and team leaders. Work includes clinical-documentation review, telephonic collaboration with case managers and attending physicians, administrative tasks, mandatory education, and staying current on internal procedures and regulatory changes. Coverage spans 8 a.m. to 3 a.m. Eastern Time, with set schedules based on business needs. Physician Advisors share responsibility for weekend and holiday coverage, and must be willing to work at least three holidays per calendar year. The role may be performed remotely from anywhere in the United States, subject to UnitedHealth Group’s telecommuter policy and requirements for a dedicated, distraction-free workspace. The position is full-time, with an annual salary range of $160,000–$300,000. Benefits include a comprehensive benefits package, incentive and recognition programs, an equity stock purchase plan, and a 401(k) contribution, subject to eligibility requirements.

Requirements

Licensed physician (MD or DO) with a current, active, unrestricted U.S. medical license.
Current board certification.
At least 3 years of experience in a hospital-based practice setting.
Computer proficiency, including navigating multiple platforms simultaneously, proficient typing, and use of Microsoft Office Suite.
Ability to have meaningful and informed conversations with case managers and attending physicians.
Willingness and ability to adhere to the role’s schedule and work evenings, weekends, and holidays as business needs require.
Willingness and ability to work at least 3 holidays per calendar year.
Ability to comply with UnitedHealth Group’s telecommuter policy; remote employees must maintain a dedicated workspace free from distractions and follow required telecommute rules and regulations.

Nice To Haves

Active, unrestricted MD or DO license in California.
Strong organization and communication skills.
Problem-solving ability.
Team-player mentality.
Strong clinical knowledge base.
Superior documentation skills.
Ability to work independently.
Self-motivation.

Responsibilities

Provide medical necessity and compliance reviews for client hospitals.
Perform concurrent peer-to-peer reviews and discussions with payor medical directors on behalf of client hospitals.
Perform written and verbal appeals on behalf of client hospitals.
Promote efficient, effective, timely, appropriate, and cost-effective clinical care guided by evidence-based medicine and regulatory requirements.
Review clinical documentation and collaborate by telephone and other interactions with hospital client case managers and attending physicians.
Promote payor and provider adherence to applicable regulatory standards and CMS policy regarding inpatient admissions, observation/outpatient status, and continued hospital stays.
Meet Optum performance and quality metrics, incorporate feedback from quality-improvement reports, and provide exceptional customer service.
Respond promptly to assistance requests from Physician Advisor team members and work collaboratively with the broader team.
Complete applicable administrative tasks, stay current on internal policies and procedures and regulatory changes, and complete and pass mandatory UHG and Optum Physician Advisor Service education modules.
Prioritize engagement and commitment to the organization, colleagues, team members, and clients.
Follow the designated schedule and UnitedHealth Group’s telecommuter policy; share weekend and holiday coverage, including at least three holidays per calendar year.