Physician Advisor
4 days 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 Financial Officer and 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, or assist the Lead Physician Advisor in chairing, the Utilization CommitteeCredentials:Doctor Osteopathic Medicine (Required) or Medical Doctor (Required) Education or Equivalent Experience:Other (Required)Education Specialization: MD or DO Minimum 5 years clinical experience in a hospital setting Possess or develop a solid foundation in the areas of utilization management and hospital operations. Possess and maintain an unrestricted medical license in the State of PennsylvaniaWe 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
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob Title: Physician AdvisorCommunity Behavioral Health is seeking a highly skilled Physician Advisor to join our team. As a Physician Advisor, you will play a critical role in providing clinical leadership and oversight of the clinical management of our members.Key Responsibilities:Provide consultation on overall quality of care, medical decision making,...
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Physician Advisor
2 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob Title: Physician AdvisorThe Physician Advisor is a critical role at Community Behavioral Health, responsible for providing clinical leadership and oversight of the clinical management of members. This position requires a strong understanding of clinical best practices, as well as the ability to communicate effectively with healthcare providers and...
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Physician Advisor
2 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob Title: Physician AdvisorCommunity Behavioral Health is seeking a highly skilled Physician Advisor to provide clinical leadership and oversight of the clinical management of members. The ideal candidate will have a strong background in psychiatry and experience in inpatient care and substance abuse treatment.Key Responsibilities:Provide consultation on...
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Physician Advisor
4 days ago
Philadelphia, United States Temple University Full timeProvides clinical expertise and guidance to Clinical Analysis and appeals team. Acts as the physician advisor for medical necessity appeals and for the Pennsylvania Medical assistance (PAMA) utilization reviews. Acts as a physician resource for the regulatory and revenue cycle denial and appeals processes for hospital activity, including utilization review...
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Physician Advisor
3 weeks ago
Philadelphia, United States Temple University Full timeProvides clinical expertise and guidance to Clinical Analysis and appeals team. Acts as the physician advisor for medical necessity appeals and for the Pennsylvania Medical assistance (PAMA) utilization reviews. Acts as a physician resource for the regulatory and revenue cycle denial and appeals processes for hospital activity, including utilization review...
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Physician Advisor
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health Full timeJob SummaryWe are seeking a highly skilled Physician Advisor to join our team at Community Behavioral Health. As a key member of our medical affairs team, you will provide clinical leadership and oversight to ensure the highest quality of care for our members.Key ResponsibilitiesProvide clinical consultation and guidance to healthcare providers and...
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Physician Advisor
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryWe are seeking a highly skilled Physician Advisor to join our team at Community Behavioral Health. As a key member of our clinical leadership team, you will be responsible for providing expert clinical guidance and oversight to ensure the highest quality of care for our members.Key ResponsibilitiesProvide clinical leadership and oversight to...
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Physician Advisor
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryWe are seeking a highly skilled Physician Advisor to join our team at Community Behavioral Health. As a key member of our clinical leadership team, you will be responsible for providing expert clinical guidance and oversight to ensure the highest quality of care for our members.Key ResponsibilitiesProvide clinical leadership and oversight to...
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Physician Advisor
2 weeks ago
Philadelphia, Pennsylvania, United States Penn Medicine Full timeJob SummaryThe Physician Advisor is a key member of the healthcare organization's leadership team, responsible for ensuring the effective and efficient utilization of healthcare services. This role requires a physician with expertise in clinical practice patterns, resource utilization, medical necessity, and compliance with governmental and private payer...
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Physician Advisor
2 weeks ago
Philadelphia, Pennsylvania, United States Pennsylvania Medicine Full timeJob SummaryPenn Medicine is seeking a highly skilled Physician Advisor to join our team. As a key member of our leadership team, you will be responsible for ensuring the effective and efficient utilization of healthcare services. You will work closely with medical staff leadership, case management, and all areas of resource management to develop and...
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Physician Advisor
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryWe are seeking a highly skilled Physician Advisor to join our team at Community Behavioral Health. As a key member of our clinical leadership team, you will play a critical role in providing clinical oversight and guidance to ensure the highest quality of care for our members.Key ResponsibilitiesProvide clinical leadership and oversight to ensure...
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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
4 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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Clinical Expert Advisor
3 weeks ago
Philadelphia, Pennsylvania, United States Temple University Full timePhysician Advisor Job DescriptionTemple Health seeks a skilled Physician Advisor to provide clinical expertise and guidance to our Clinical Analysis and appeals team. As a key member of our team, you will act as a physician advisor for medical necessity appeals and for the Pennsylvania Medical Assistance (PAMA) utilization reviews.Key...
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Physician Advisor
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryWe are seeking a highly skilled Physician Advisor to join our team at Community Behavioral Health. As a key member of our clinical leadership team, you will be responsible for providing expert clinical guidance and oversight to ensure the highest quality of care for our members.Key ResponsibilitiesProvide clinical leadership and oversight to...
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Physician Advisor
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryWe are seeking a highly skilled Physician Advisor to join our team at Community Behavioral Health. As a key member of our clinical leadership team, you will play a critical role in providing clinical oversight and guidance to our care management team.Key ResponsibilitiesProvide clinical leadership and oversight to ensure high-quality care for our...
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Physician Advisor
3 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryWe are seeking a highly skilled Physician Advisor to join our team at Community Behavioral Health. As a key member of our clinical leadership team, you will be responsible for providing expert clinical guidance and oversight to ensure the highest quality of care for our members.Key ResponsibilitiesProvide clinical leadership and oversight to...
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Physician Advisor
4 weeks ago
Philadelphia, Pennsylvania, United States Community Behavioral Health. Full timeJob SummaryWe are seeking a highly skilled Physician Advisor to join our team at Community Behavioral Health. As a key member of our clinical leadership team, you will be responsible for providing expert clinical guidance and oversight to ensure the highest quality of care for our members.Key ResponsibilitiesProvide clinical leadership and oversight to...
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Physician Advisor
4 weeks ago
Philadelphia, PA, United States Community Behavioral Health. Full timeThe 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 care or cohort. Community Behavioral Health offers a very competitive compensation and benefits package, including: ~ 403B Retirement Plan ~ Employee...
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Physician Advisor
1 week ago
New Philadelphia, Pennsylvania, United States Community Behavioral Health Full timeJob SummaryThe Physician Advisor is a key member of our clinical leadership team, responsible for providing expert guidance on clinical management and quality of care for our members. This role requires a strong understanding of medical decision-making, case formulations, and medication safety concerns.Key ResponsibilitiesProvide clinical leadership and...
