Physician Advisor - Concurrent Appeals & Denials - Remote

UnitedHealth Group•Newtown Square, PA

5d•$160,000 - $300,000•Remote

About The Position

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results improve lives? Join us to start Caring. Connecting. Growing together. In this Physician Advisor role, you will partner with providers, case managers, and payors to conduct medical necessity reviews, facilitate peer-to-peer discussions, manage appeals, and ensure appropriate patient status determinations. This position offers the opportunity to leverage your clinical expertise to support quality outcomes, compliance, and cost-effective care across client health systems.

Requirements

Licensed Physician (MD or DO) with a current, active, unrestricted Medical License in the U.S.
Current Board Certification
3+ years of experience in a hospital-based practice setting
Demonstrated computer proficiency (i.e., navigating multiple platforms simultaneously, proficient typing skills, MS Office Suite, etc.)
Demonstrated ability to have meaningful and informed conversations with Case Managers and Attending Physicians
Must be willing/able to adhere to the schedule expectations of the role and flexible to work evenings/weekends/holidays as business needs dictate and require
Must be willing/able to work at least 3 holidays per calendar year
Dedicated remote workspace free from distractions following the company required telecommute compliance rules and regulations
Work the designated schedule required per business needs
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nice To Haves

Active, unrestricted MD or DO License in CA
Solid organization and communication skills
Problem solving
Team player mentality
Solid clinical knowledge base
Superior documentation skills
Work Independently
Self-motivated

Responsibilities

Provide medical necessity and compliance reviews for our client hospitals
Perform concurrent peer to peer reviews with payor medical directors
Perform written and verbal appeals
Promote efficient and effective clinical care of hospitalized patients delivered in a timely, appropriate and cost-effective fashion as guided by evidenced based medicine and regulatory requirements via review of clinical documentation, collaborative telephonic communication and other interactions with hospital client Case Managers and Attending Physicians
Promote payor and provider adherence to all applicable regulatory standards and CMS policy regarding inpatient admissions, observation/outpatient status, and the appropriate status for continued hospital stays
Meet Optum performance and quality metrics while incorporating feedback from quality improvement reports and providing exceptional customer service
Function as a vital aspect of a team consisting of other Physician Advisors, Nurses, Administrative Assistants, Clinical Relationship Managers, and Team Leaders with prompt responses to requests for assistance from any members of that team
Performing all applicable administrative tasks, staying abreast of internal policies/procedures, regulatory changes and updates within the business segment, and completing and passing mandatory UHG and Optum Physician Advisor Service education modules
Make engagement an area of focus and priority with commitment to the organization, colleagues and team members, as well as our clients
Performing concurrent peer-to-peer discussions with payor medical directors on behalf of client hospitals
Performing written and verbal appeals on behalf of client hospitals