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Onsite Physician Advisor Albuquerque NM

Company: UnitedHealth Group
Location: Albuquerque
Posted on: May 15, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing -your life's best work.(sm) -This position is for qualified physicians seeking to enter the new and growing non-clinical practice specialty of Physician Advisor with a career trajectory towards a provider or payor medical director and beyond. This position drives performance across our organization by communicating with hospital physicians and utilization management staff at client hospitals to champion best practices for evidence-based care and its documentation. The Physician Advisor will be responsible for establishing, maintaining, and strengthening the relationship with Optum client hospitals to appropriately optimize the use of Optum services. -Training will be provided by Optum. The Physician Advisor will join a team of on-site physician advisors across the country. -Although the Physician Advisor (PA) is employed by Optum, the intention is that the PA will become a key member of the client hospital's leadership team charged with meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. To this end, the PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial management, and compliance with governmental regulations and commercial insurance contracts. -The Physician Advisor will work closely with the medical staff, including house staff, hospital leadership, and all utilization management (UM) personnel to develop and implement methods to optimize the use of hospital services. This includes care management processes that ensure patients are in the appropriate level of care with supporting documentation for regulatory compliance and accurate coding. -Primary Responsibilities:

  • Conduct medical necessity reviews of cases referred by case management to ensure medical necessity and regulatory requirements are met for level of care
  • Meet with case management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status -
  • Interact with medical staff and medical directors of third-party payers to discuss the needs of patients and alternative levels of care
  • Act as a consultant for the medical staff regarding their decisions for the appropriate level of care of hospitalized patients and supporting documentation
  • Participate in the claims denial process, including appeals
  • Review of utilization data to ensure hospital objectives for quality patient care
  • Act as a resource for the medical staff regarding federal, state, and payer regulatory, quality, and contract requirements
  • Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application
  • Provide education on utilization management topics (e.g., documentation) to the medical and UM staffs -Physician Advisor Will Not:
    • Practice medicine during the hours scheduled, which includes:
    • Decision-making in a patient's plan of care or discharge
    • Write orders or prescriptions
    • Provide on-call coverage
    • Set hospital clinical or administrative policies
    • Supervise house staff or hospital employees
    • Participate in any type of peer review (e.g., Quality, M&M) -You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:MD or DOCurrent, unrestricted medical license in state of residenceDemonstrated ability to build rapport with medical staff and hospital leadershipSolid computer skills and working knowledge of EMRsYou will be asked to perform this role in an office setting, however, may be required to work from home temporarily due to space limitationsEmployees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained -Preferred Qualifications:3+ years of experience in a hospital-based practice settingBoard Certified / Eligible

Keywords: UnitedHealth Group, Albuquerque , Onsite Physician Advisor Albuquerque NM, Healthcare , Albuquerque, New Mexico

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