Physician Advisor (Part-Time)

Xsolis, Inc

13h•Hybrid

About The Position

Xsolis is an AI-driven technology company focused on reducing administrative waste in healthcare through enhanced collaboration between providers and payers. Our mission is to create a more efficient healthcare system. We are based in Franklin, TN, a growing hub for healthcare innovation. Our product, Dragonfly®, uses AI to predictively score medical necessity, having served over 600 clients and receiving industry recognition. We are seeking talented individuals to join our expanding team. The Physician Advisor role involves providing concurrent review and appeal support services for XSOLIS’s XPAS client base. This position requires professional expertise and a commitment to innovation. Key skills include experience with utilization management, understanding of state and federal regulations, knowledge of the denials and appeals process, and familiarity with physician documentation and electronic health records. The Physician Advisor will apply their practical knowledge to a solution aimed at transforming how hospitals manage administrative challenges.

Requirements

Graduate of an accredited medical school
Additional education in quality and utilization management through continuing medical education programs and self-study
5 years recent experience in clinical practice
Licensed physician without restrictions
Knowledge of federal, state, and payer regulatory and contract requirements
Verbal and written communication skills
Basic computer skills, including typing, navigating browsers, etc.
MS Office Suite
Professional demeanor and interpersonal skills
Must successfully pass a background check and fall under the same security role, which includes access to sensitive information, including proprietary data and PHI.
Must be authorized to work in the United States on a full-time, permanent basis without the need for current or future sponsorship.

Nice To Haves

Utilization management experience as a member of the UM oversight committee or past physician advisor experience preferred

Responsibilities

Provide clinical reviews in accordance with Managed Care and CMS Regulatory Requirements to assist with level of care and length of stay management on a case-by-case basis.
Assist with the denial management process.
Determine if professionally recognized standards of quality care are met.
Participate in the concurrent and retrospective appeal peer-review process.
Provide feedback to internal and external partners regarding level of care, length of stay and quality issues, which may also include joining client meetings to review observations and trends in physician behavior and/or documentation.
Recommend and request additional, more complete, medical record documentation.
Provide guidance to internal and external staff regarding status issues and alternatives to acute level of care when such care is not warranted.
Provide education to internal and external staff related to regulatory requirements, appropriate utilization, and alternative levels of care.
Ensure appropriate documentation of patient care reviews, decisions, and other pertinent information.
Be able to review cases with screening criteria, such as InterQual, MCG or other appropriate platforms.
Develop and apply protocols related to evidence-based medicine and criteria.
Work with internal and external Care Management staffs to ensure appropriate continuity of care and provide education to assist in reducing readmissions.
Educate internal and external staff about ICD coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology to improve their understanding of severity, acuity, risk of mortality, and DRG assignments on their individual patient records.
Provide insight into the development of the XSOLIS appeal operations and technology platform.
Work with the Data Analytics team and assist in the enhancement of clinical analytics.
Maintain current knowledge of federal, state, and payer regulatory and contract requirements.
Complete peer to peer reviews (for full-time advisors).
Perform additional functions as deemed appropriate and warranted.