Physician Advisor

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.

Come make an impact on the communities we serve as you help us advance health equity on a global scale. As a Physician Advisor, you will be responsible for establishing, maintaining, and strengthening the relationship with Optum client hospitals to appropriately optimize the use of Optum services.

Key Responsibilities:

• Conduct second-level medical necessity/compliance status reviews for all payor types
• Meet with case management, utilization management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status through case reviews
• Interacting with medical staff to discuss medical necessity and concurrent denial cases
• Act as a consultant for the medical staff regarding their decisions for the appropriate medical necessity status of hospitalized patients and supporting documentation
• Participate in the claims denial process by conducting peer-to-peer discussions with commercial payor medical directors for cases that have been denied concurrently
• Coordinate with Optum/OPAS Subject Matter Expert(s) for questions regarding federal, state, and payor and regulatory requirements
• Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application
• Provide focused case-by-case education on utilization management topics (e.g., documentation) to the medical and UM staff
• Develop and maintain a working knowledge and understanding of OPAS proprietary guidance regarding clinical diagnoses and disease states. Initial and ongoing training will be provided by OPAS

Requirements:

• MD or DO
• Current, unrestricted medical license in Pennsylvania
• Demonstrated ability to build rapport with medical staff and hospital leadership
• Solid computer skills and working knowledge of EMRs
• Receptive to feedback and coaching
• 3+ years of experience in a hospital-based practice setting
• Solid communication and listening skills
• Ability to collaborate and partner with multiple constituents (administrative, clinical, leadership, etc.)

Preferred Qualifications:

• Board Certified / Eligible
• Physician Advisor and/or Utilization Review experience

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone – of every race, gender, sexuality, age, location, and income – deserves the opportunity to live their healthiest life.

Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere:

UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.