Physician Advisor
2 months ago
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?Summary:The Physician Advisor is a key member of the healthcare organization's leadership team and is charged with meeting the organization's goals and objectives for assuring the effective and efficient utilization of health care services. The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. The Physician Advisor shall possess and/or develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, and appropriate physician documentation requirements. Reporting directly to the Chief Medical Officer, the Physician Advisor works closely with medical staff leadership, medical staff, and all areas of resource management, case management, social services, discharge planning, and utilization management to develop and implement methods to optimize use of hospital services.Responsibilities:• Make recommendations on level of care including initial level of care, secondary review, and as requested by case management • Review for daily level of care recommendations on cases placed in Observation • Participate in the denials management process • Be a leader in optimizing denial management • Perform peer to peer appeals and draft appeal letters for third party denials where appropriate • Apply the 2 midnight rule to Medicare reviews • Maintain compliance with Medicare rules as it applies to level of care recommendations • Stay current on changes in payer rules including CMS rules as it pertains to utilization review • Recommend and request additional and more complete medical record documentation from providers to support placement status or medical necessity • Understand and use InterQual and/or other appropriate criteria • Apply medical expertise to assist with appropriate billing for services • Provide feedback to Contracting on payer denial patterns where appropriate • Facilitate, mentor, and educate other physicians regarding documentation and payer requirements.• Facilitate, mentor, and educate case management on the utilization review process where appropriate•Chair the Utilization Committee•Performs duties in accordance with Penn Medicine and entity values, policies, and procedures •Other duties as assigned to support the unit, department, entity, and health system organizationCredentials:Must possess and maintain an unrestricted medical license in the State of Pennsylvania as a Medical Doctor or Doctor of Osteopathic Medicine (MD / DO Required)Education or Equivalent Experience:MD or DO With a minimum 5 years clinical experience in a hospital setting.Possess or develop a solid foundation in the areas of utilization management and hospital operations.We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.Live Your Life's WorkWe are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.
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Physician Advisor
2 months ago
Philadelphia, United States Pennsylvania Medicine Full timePenn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn...
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Physician Advisor
2 months ago
Philadelphia, United States Pennsylvania Medicine Full timePenn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. Today at Penn...
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Physician Advisor
3 weeks ago
Philadelphia, United States Community Behavioral Health. Full timeJob DescriptionJob DescriptionThe Physician Advisor is responsible for providing clinical leadership through oversight of the clinical management of members. The Physician Advisor provides consultation regarding overall quality of care, medical decision making, case formulations, medication and other safety concerns, specific to case review and levels of...
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Physician Advisor
2 months ago
Philadelphia, United States Community Behavioral Health. Full timeJob DescriptionJob DescriptionThe Physician Advisor is responsible for providing clinical leadership through oversight of the clinical management of members. The Physician Advisor provides consultation regarding overall quality of care, medical decision making, case formulations, medication and other safety concerns, specific to case review and levels of...
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Clinical Advisor in Psychiatry
1 week ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timePosition Overview:The Clinical Advisor plays a crucial role in providing expert consultation on the overall quality of care, medical decision-making, and safety concerns related to case reviews and levels of care. Key Responsibilities:- Conducts physician reviews in accordance with best practice standards and regulatory requirements, aiming to enhance...
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Philadelphia, Pennsylvania, United States LocumJobsOnline Full timeAbout the PositionA healthcare organization is seeking an Emergency Medicine Physician for locum tenens coverage. The facility is located in a rural area and requires a qualified physician to provide medical care to patients. The schedule is 12-hour shifts, and the facility has a Cerner electronic health record system with Dragon speech recognition...
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Philadelphia, Pennsylvania, United States LocumJobsOnline Full timeAbout the PositionWe are seeking a highly skilled Anesthesiology Specialist to join our team at a Level I Trauma Center. This is a hospital-employed position that offers a unique opportunity to work with a growing Anesthesiology Program.Key Responsibilities:Provide high-quality patient care as a Specialist in AnesthesiologyCollaborate with Faculty and Staff...
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Philadelphia, Pennsylvania, United States LocumJobsOnline Full timeAbout the PositionPenn-York Valley Primary Care Expansion: A Competitive Compensation PackageA leading healthcare organization is seeking a Board Certified Internal Medicine MD/DO to join their team in a employed position with a generous salary guarantee and bonus structure. The ideal candidate will have an active Pennsylvania license and experience in...
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Trauma Surgery Physician Assistant
2 weeks ago
Philadelphia, Pennsylvania, United States Thomas Jefferson University & Jefferson Health Full timePRIMARY FUNCTION : The primary responsibility of this role is to assist the surgeon in performing diagnostic and therapeutic tasks, enhancing the physician's ability to deliver effective patient care. The individual will support the surgeon in decision-making processes essential for establishing diagnoses and planning treatment strategies. This position...
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Trauma Surgery Physician Assistant
2 weeks ago
Philadelphia, Pennsylvania, United States Thomas Jefferson University & Jefferson Health Full timePRIMARY FUNCTION : The primary role involves performing diagnostic and therapeutic procedures under the supervision of a surgeon, enhancing the physician's ability to deliver effective patient care. This position entails assisting in the collection of necessary data to implement the surgeon's therapeutic plan. The individual must be qualified to provide...
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Philadelphia, United States LocumJobsOnline Full timeLocumJobsOnline is working with Healthcare Connections to find a qualified Psychiatry MD in Pennsylvania, Pennsylvania!About The PositionWestern Pennsylvania Outpatient PsychiatristExciting opportunity in the sought-after northern Pittsburgh market for a Psychiatrist to join a busy, established practice & take over an established panel due to a departing...
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Clinical Oversight Physician
1 week ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob OverviewThe Physician Advisor plays a pivotal role in delivering clinical guidance by overseeing the healthcare management of members. This position involves providing expert consultation on the quality of care, medical decision-making, case evaluations, and safety issues related to case reviews and levels of care.Benefits Offered:Family Planning,...
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Medical Director for Adult Services
3 days ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryWe are seeking a highly skilled and experienced Medical Director for Adult Services to join our team at Community Behavioral Health. The successful candidate will provide administrative oversight and supervision of our physician advisors, ensuring the delivery of high-quality care to our adult members.Key ResponsibilitiesLeadership and...
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Philadelphia, United States LocumJobsOnline Full timeLocumJobsOnline is working with Healthcare Connections to find a qualified Dermatology MD in Pennsylvania, Pennsylvania!About The PositionPennsylvania GROWING Dermatology GroupAn exciting opportunity awaits in northern Pennsylvania with a physician-led, non-profit hospital system serving New York and Pennsylvania for 100+ years! This is a hospital employed...
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Philadelphia, United States LocumJobsOnline Full timeLocumJobsOnline is working with Healthcare Connections to find a qualified Dermatology MD in Pennsylvania, Pennsylvania!About The PositionPennsylvania GROWING Dermatology GroupAn exciting opportunity awaits in northern Pennsylvania with a physician-led, non-profit hospital system serving New York and Pennsylvania for 100+ years! This is a hospital employed...
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Philadelphia, United States LocumJobsOnline Full timeLocumJobsOnline is working with Healthcare Connections to find a qualified Otolaryngology MD in Pennsylvania, Pennsylvania!About The PositionPennsylvania Otolaryngology + $200,000 DIRECT Loan RepaymentAn exciting opportunity awaits in the Penn-York Valley with a hospital system serving New York and Pennsylvania for more than 100 years! This is a hospital...
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Trauma Surgery Physician Assistant
2 weeks ago
Philadelphia, Pennsylvania, United States Thomas Jefferson University & Jefferson Health Full timePRIMARY FUNCTION : The primary role involves performing diagnostic and therapeutic tasks under the guidance of a supervising surgeon. This position is essential in enhancing the physician's capacity to make informed decisions for accurate diagnoses and effective treatment planning. The individual will assist in collecting necessary data to implement the...
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Philadelphia, United States LocumJobsOnline Full timeLocumJobsOnline is working with Healthcare Connections to find a qualified Internal Medicine MD in Pennsylvania, Pennsylvania!About The PositionPenn-York Valley Primary Care Expansion: $tipend$A physician-led, non-profit hospital system is actively recruiting Internal Medicine physicians to join multiple practices in the Penn-York Valley due to growth!...
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Philadelphia, United States LocumJobsOnline Full timeLocumJobsOnline is working with Healthcare Connections to find a qualified Internal Medicine MD in Pennsylvania, Pennsylvania!About The PositionPenn-York Valley Primary Care Expansion: $tipend$A physician-led, non-profit hospital system is actively recruiting Internal Medicine physicians to join multiple practices in the Penn-York Valley due to growth!...
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Philadelphia, United States LocumJobsOnline Full timeLocumJobsOnline is working with Healthcare Connections to find a qualified Hospitalist MD in Pennsylvania, Pennsylvania!About The PositionEastern Pennsylvania DAYS ONLY HospitalistAn established hospitalist program is actively recruiting to add 2 physicians to the dayside team for keep up with an increased census and growing community. Come be a part of an...
