Physician Advisor

CommonSpirit Health, a leading healthcare provider, is seeking a skilled Physician Advisor to join our team. As a remote position, this role will play a critical part in our Utilization Management team.

• Conduct clinical case reviews to ensure quality patient care and efficient utilization of healthcare services.
• Meet with case management and healthcare team members to discuss selected cases and make recommendations for care.
• Interact with medical staff members and medical directors of third-party payers to discuss patient needs and alternative levels of care.
• Perform denials management and prevention in accordance with organizational goals and expectations.
• Review cases for medical necessity, clinical validation, and participate in appeal letter writing.
• Act as a consultant to attending physicians regarding their decisions relative to appropriateness of hospitalization, clinical documentation, and use of healthcare resources.
• Facilitate training for physicians and serve as a resource for the medical staff regarding federal and state utilization and quality regulations.

• Unrestricted license in the field of practice in the state of California.
• Broad knowledge base with trust and respect of medical staff physicians.
• In-depth knowledge of CMS regulations, including the 2-midnight rule.
• Utilization management experience.
• Education in quality and utilization management through continuing medical education programs and self-study.