Physician Advisor
12 hours ago
Penn 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 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 Committee.
- Doctor of Osteopathic Medicine (DO) or Medical Doctor (MD) degree.
- Minimum 5 years of 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 Pennsylvania.
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.
-
Physician Advisor
3 days 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,...
-
Physician Advisor
4 days 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...
-
Physician Advisor
6 days 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...
-
Physician Advisor
6 days 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...
-
Physician Advisor
5 days 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...
-
Clinical Expert Advisor
3 days 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...
-
Physician Advisor
1 week 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...
-
Physician Advisor
6 days 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...
-
Physician Advisor
1 week 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...
-
Physician Advisor
1 week 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...
-
Physician Consultant
3 days ago
Philadelphia, Pennsylvania, United States Community Behavioral Health Full timeJob Title: Physician AdvisorThe Physician Advisor is a key member of our clinical team, responsible for providing expert clinical leadership and oversight of the clinical management of our members.Key Responsibilities:Provides consultation on overall quality of care, medical decision making, case formulations, and medication safety concerns.Reviews cases...
-
GME/Immigration Advisor
1 day ago
Philadelphia, Pennsylvania, United States Intealth Full timeAbout the RoleWe are seeking a highly skilled and experienced GME/Immigration Advisor to join our team at Intealth. As a key member of our Exchange Visitor (J-1 Visa) Sponsorship Program (EVSP) department, you will play a critical role in supporting foreign national physicians participating in U.S. graduate medical education (GME) and building vital...
-
Clinical Advisor in Psychiatry
4 weeks 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...
-
Physician - Endocrinology Specialist
2 weeks ago
Philadelphia, Pennsylvania, United States LocumJobsOnline Full timeAbout the PositionWe are seeking a Board Certified Endocrinology MD/DO to join our established practice and service line in northern Pennsylvania. This is a hospital employed position with an experienced team, including physicians, nurse practitioners, RN's, Registered Dietitians, and Certified Diabetes Educators.The ideal candidate will have leadership...
-
Philadelphia, Pennsylvania, United States LocumJobsOnline Full timeAbout the PositionWe are working with a reputable healthcare organization to find a qualified Dermatology MD in Pennsylvania. This is a hospital-employed position to join an established practice and take over for a retiring physician.The ideal candidate is a Board Certified Dermatology MD/DO interested in a general Derm practice with an active Pennsylvania...
-
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...
-
Child and Adolescent Psychiatry Physician
2 weeks ago
Philadelphia, Pennsylvania, United States Allied Psych Advisors Full timeAllied Psych Advisors is seeking a skilled Psychiatry-Child/Adolescent Physician to join our team.We are a leading provider of mental health services, and we are committed to delivering high-quality care to our patients.The ideal candidate will have a strong background in child and adolescent psychiatry, with excellent clinical skills and a passion for...
-
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...
-
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...
-
Medical Director for Adult Services
3 weeks 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...
