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Physician Consultant

2 months ago

Clairton, Pennsylvania, United States Highmark Health Full time
Job Summary

We are seeking a highly skilled Physician Advisor to join our team at Highmark Health. As a Physician Advisor, you will play a critical role in evaluating the medical necessity and appropriateness of patient care, working closely with our healthcare team to ensure the best possible outcomes.

Key Responsibilities
  • Evaluate Medical Necessity: Collaborate with admitting physicians, case managers, and other hospital personnel to assess the medical necessity of patient admissions, observation status, and ancillary services.
  • Provide Medical Expertise: Offer medical advice and support to our Case Management Department, providing education to the medical staff on medical necessity and appropriateness of healthcare services.
  • Facilitate Communication: Facilitate communication between attending physicians, case managers, and other healthcare professionals to ensure seamless patient care.
  • Participate in Quality Improvement: Participate in data collection activities and contribute to resource utilization management to drive quality and reduce length of stay.
  • Collaborate with Payers: Collaborate with insurance company physician administrators to obtain payer authorization and participate in contract reviews to determine criteria for avoiding unnecessary denials.
Requirements
  • Education: Doctorate in Medicine (MD) or Doctor of Osteopathic Medicine (DO)
  • Experience: 5 years of clinical practice experience in a hospital setting, with experience as a Physician Advisor in a clinical setting preferred.
  • Certifications: Board Eligible or Board Certified in a relevant specialty