Physician Advisor
St. Joseph's Health•Paterson, NJ
•$160 - $180•Onsite
About The Position
The Physician Advisor (PA) role is responsible for completing detailed reviews of complex patient cases to ensure appropriate plan of care and resource management. An enhanced case review by the PA is necessary to reduce denials and resource utilization issues. PA responsibilities include but are not limited to enhanced utilization review, comprehensive management of denials and appeals, effective partnership with Care Management and Social Work, expertise in insurance regulation and compliance, and availability for provider education.
Requirements
- Physician expertise in insurance regulation and compliance.
- Ability to partner effectively with Care Management and Social Work.
- Availability for provider education.
Responsibilities
- Completing detailed reviews of complex patient cases to ensure appropriate plan of care and resource management.
- Reducing denials and resource utilization issues through enhanced case review.
- Conducting enhanced utilization reviews.
- Managing denials and appeals comprehensively.
- Partnering effectively with Care Management and Social Work.
- Providing expertise in insurance regulation and compliance.
- Being available for provider education.
- Assuring UM program elements are in place and functioning off-hours.
Benefits
- Competitive salary
- Robust benefits with health, dental, Rx and vision plans
- 403b retirement plan options with company match
- Health & Wellness
- Non-Profit Health System – eligible for Federal Student Loan Forgiveness
- PTO, and paid holidays
- Tuition reimbursement
- Employee Assistance Program
- LTD : Long Term Disability
- Life Insurance Options
- Onsite Day care Program
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What This Job Offers
Job Type
Part-time
Career Level
Senior
Education Level
Ph.D. or professional degree
