110 physician advisor jobs found

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Thank you for considering a career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession:  Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas:  Continuously innovate by embracing emerging technology and fostering a culture of creativity and...

Department: 11200 Advocate Christ Medical Center - Case Management Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Monday-Friday 0800-1630 with weekend and holiday rotation. Pay Range: $38.20 - $57.30 MAJOR...

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Per Diem Job Description: Beth Israel Deaconess Hospital-Plymouth recognizes Integrity, Respect, Trust, Teamwork and Excellence as the Core Values of our organization.  It is the philosophy of BID-Plymouth to follow the LEAN methodology in order to provide the full continuum of health care services and the best quality patient centered care. Duties/Responsibilities: Reviews admission data to establish the appropriate level of care using Interqual criteria. Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. Conducts concurrent reviews to determine the continued need for acute care setting, appropriateness and timeliness of treatments/procedures and to optimize the potential for reimbursement. Collaborates with the multidisciplinary team...

Registered Nurse (RN) - Utilization Management FT Day Shift (Hrs.: 8a-4:30p) - On-site Newark, DE ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with experience with insurance providers such as Aetna and Cigna, along with a background in an acute care hospital. RN will work on-site at the Newark Hospital. PRIMARY FUNCTION: Responsible for ensuring the delivery of efficient and effective health care while evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan. UTILIZATION MANAGEMENT Performs admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission. Reviews the admission assessment and collaborates with primary nurse and other health care providers to...

Description Roles and Responsibilities Overview The Physician Advisor is a full-time administrative physician role serving CHRISTUS St. Michael hospital and its affiliates through teaching, consulting, and advising both the Care Management Department and the medical staff on matters regarding physician practice patterns, documentation, over- and under-utilization of resources, medical necessity, compliance rules and regulations, collaboration and relationships with payers, and the community. The PA also ensures physician support and execution for the Care Management and CDI Departments' initiatives by promoting effective and efficient physician documentation to support the patient's Level of Care (LOC), billing status, and appropriateness of Medicare Severity-Diagnosis Related Group (MS-DRG)/DRG assignment. The PA will submit monthly time records documenting time actually spent in the provision of the responsibilities outlined below. M-F, no call responsibilities! Reporting...

Job Summary: Responsible for optimizing quality and efficiency of care for hospitalized members by conducting daily utilization and quality reviews, discharge planning, and care coordination. Collaborates with physicians and multidisciplinary teams, developing safe discharge plans, and ensuring compliance with all relevant regulations. The role promotes high customer satisfaction and achieves desired utilization and quality outcomes for the population served. Essential Responsibilities: Utilizes established criteria, to perform daily inpatient review activities, including prospective, concurrent, and retrospective utilization review for all members requiring inpatient admission. Performs an admission utilization review upon admission. Assesses discharge planning needs and documents assessment using designated tools in EMR for all new inpatient admissions within 24 hours and begins the discharge planning process immediately. Conducts a concurrent utilization review...

Job Summary: Responsible for optimizing quality and efficiency of care for hospitalized members by conducting daily utilization and quality reviews, discharge planning, and care coordination. Collaborates with physicians and multidisciplinary teams, developing safe discharge plans, and ensuring compliance with all relevant regulations. The role promotes high customer satisfaction and achieves desired utilization and quality outcomes for the population served. Essential Responsibilities: Utilizes established criteria, to perform daily inpatient review activities, including prospective, concurrent, and retrospective utilization review for all members requiring inpatient admission. Performs an admission utilization review upon admission. Assesses discharge planning needs and documents assessment using designated tools in EMR for all new inpatient admissions within 24 hours and begins the discharge planning process immediately. Conducts a concurrent utilization review...

Job Summary: Responsible for optimizing quality and efficiency of care for hospitalized members by conducting daily utilization and quality reviews, discharge planning, and care coordination. Collaborates with physicians and multidisciplinary teams, developing safe discharge plans, and ensuring compliance with all relevant regulations. The role promotes high customer satisfaction and achieves desired utilization and quality outcomes for the population served. Essential Responsibilities: Utilizes established criteria, to perform daily inpatient review activities, including prospective, concurrent, and retrospective utilization review for all members requiring inpatient admission. Performs an admission utilization review upon admission. Assesses discharge planning needs and documents assessment using designated tools in EMR for all new inpatient admissions within 24 hours and begins the discharge planning process immediately. Conducts a concurrent utilization review...

The Physician Advisor (PA) is a clinical leader responsible for ensuring appropriate patient care, optimizing resource utilization, and maintaining regulatory compliance. The PA conducts medical necessity and utilization reviews, manages denials and appeals, advises providers on patient status and documentation, and collaborates with Care Management and hospital leadership to improve throughput, length of stay, and overall quality outcomes.

Overview: The Physician Advisor conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients and strengthening relationships between Clinical Revenue Cycle, UR, hospital leadership, medical staff, and hospital ICM. The Physician Advisor interfaces directly with the medical staff, providing concurrent communication and education to attending physicians (and their APCs) regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered. As this role's duties include significant interpersonal and relational aspects in...

Location Detail: 1290 Silas Deane Hwy Wethrsfld (10181) Clinical Resource Management Physician Advisor (Full-Time) At Hartford HealthCare in Connecticut Every day, more than 40,000 Hartford HealthCare colleagues come to work united by one shared purpose: knowing every moment matters. As Connecticut's most comprehensive, physician-led healthcare network, we are transforming the delivery of care through innovation, collaboration, education, and excellence. We invite you to join a nationally recognized health system where physicians are empowered to lead, collaborate, and make a meaningful impact on patient care across the continuum. About Hartford HealthCare Hartford HealthCare is one of the nation's most integrated healthcare systems, serving patients at more than 500 locations across Connecticut, including eight acute care hospitals, a large multispecialty physician group, behavioral health services, rehabilitation, home care, senior services, and an extensive...

DESCRIPTION OF POSITION: The Oncology Date Specialist accessions, abstracts and maintains records of all patients diagnosed and or treated for cancer by utilizing the cancer registry data system. The information in the cancer registry system is used to provide data for physicians and research studies. The ODS aides the ODS-Coordinator with the analysis of data and dissemination of information within established guideline and in accordance with professional ethics, assist the ODS-Coordinator with weekly Tumor Board, Annual Report, Quality Control and other functions as needed. Participates in performance improvement. SUPERVISION: Reports directly to the Oncology Date Specialist Coordinator RESPONSIBILITIES AND DUTIES: Identifies and compiles patient data from a range of relevant sources. Uses reports from a variety of multiple medical facilities, pathology reports. Able to enter data into the computer through accurate use of the software program. Codes site...

Department: 11200 Advocate Condell Medical Center - Case Management Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: M-F 8:00 to 4:30pm. Rotating weekends every 6-8 weeks, rotating holidays. Pay Range: $38.20 - $57.30...

Registered Nurse (RN) - Utilization Management FT Day Shift (Hrs.: 8a-4:30p) - On-site Newark, DE ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with experience with insurance providers such as Aetna and Cigna, along with a background in an acute care hospital. RN will work on-site at the Newark Hospital. PRIMARY FUNCTION: Responsible for ensuring the delivery of efficient and effective health care while evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan. UTILIZATION MANAGEMENT Performs admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission. Reviews the admission assessment and collaborates with primary nurse and other health care providers to...

For the quickest response, please apply directly via CorroHealth's website. Click Company>Careers>USA>search Medical Director >Apply. Thank you. About CorroHealth: At CorroHealth our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: As a Medical Director, Denials Management you will have the unique opportunity to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert advisor to client hospitals. You will perform clinical case reviews and provide...