114 physician advisor jobs found

Summary: The Physician Advisor, in partnership with Care Management leadership, acts as a champion of high-quality admissions and all transitions of care across the continuum. The Physician Advisor acts as an advisor, educator and administrative support to Care management and the Care Transitions Program. The Advisor also serves as a liaison between these programs, the hospital's medical leadership and physician staff. The advisor communicates and provides data to physicians, care managers, nurses and other clinical staff related to the efficient and effective utilization of clinical resources. The advisor serves as a liaison to third party payers concerning matters related to utilization review, care coordination and transitions of care planning. Serves as clinical resource to the department of Care Management. Provides clinical knowledge and expertise to guide care management assessment, planning and interventions. Serves as an advisor to hospital administration, the...

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...

Summary: The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment. Interfaces with 3rd party payers by providing pertinent, relevant clinical information. Responsibilities Include: Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Enters clinical reviews into the software program. Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor. Monitors and identifies patterns or trends in utilization management. Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in software program the actions taken to coordinate care and avoid...

Work Schedule: This is an EVERY Saturday and Sunday role Summary: The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment. Interfaces with 3rd party payers by providing pertinent, relevant clinical information. Responsibilities Include: Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Enters clinical reviews into the software program. Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor. Monitors and identifies patterns or trends in utilization management. Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in...

About this Job: General Summary of Position Participates in the continuous systematic monitoring of all MedStar Family Choice participating provider processes and outcomes; directs problem focused studies; implements and maintains department objectives to ensure compliance of NCQA accreditation Federal/State regulations licensing or reviewing agency requirements; liaison for Quality Improvement Committees. The ideal candidate should be a critical thinker with practical experience in patient care public health quality improvement and the assessment of quality improvement initiatives as well as writing for diverse audiences and can independently assess which data management and statistical strategies when needed to optimally report outcomes. Background with HEDIS & Excel is strongly desired. The candidate should also have the ability to assess medical records and make determinations on clinical criteria with policies and procedures.We recruit retain and advance associates...

Join Tenet Healthcare as a Physician Advisor and Drive Meaningful Change (ON SITE) Come to Palm Beach Gardens, FLA and take your career to the next level! Tenet Healthcare is seeking a board certified, physician to join our leadership team. This is an ON-SITE, full-time position. While experience as a PA is preferred, candidates with a strong desire to succeed will be considered. In this pivotal role, youll influence utilization management, documentation integrity, and physician education to improve patient care and hospital performance. What Youll Do Review cases for appropriate Level of Care and monitor observation stays Educate physicians and committees on utilization and documentation best practices Lead daily huddles, complex case conferences, and peer education Chair the Utilization Management Committee quarterly Manage payer denials, including peer-to-peer reviews Partner with CDI/HIM teams to improve documentation quality Partner with administration in...

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...

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...

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...

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...

Department: 11210 Aurora St. Lukes Medical Center - Social Services Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: M-F 0800-1630 with availability/accountability to team during off hours and holidays. Pay Range:...

About the Job Physician Advisor - MedStar Multisite MedStar Health is seeking a Physician Advisor to join our team in a hybrid role supporting hospitals across the MedStar Health System. The Physician Advisor is an essential part of the team, using medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials. Their work ensures patients receive appropriate, timely care. In this role, you'll: Review patient status, medical necessity, and level of care Lead clinical denial interventions, denial root cause determinations and upstream process improvement initiatives Engage in concurrent and retrospective denials management and peer to peer discussions with payers Drive length of stay improvements in close collaboration with case management and hospital stakeholders Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community...

Department: 11211 Advocate Christ Medical Center - Social Services: ACH Status: Part time Benefits Eligible: Yes Hou rs Per Week: 20 Schedule Details/Additional Information: float position, part time including 2 Saturdays a month. Cover for PTO and support high census areas...

Department: 11200 Advocate Christ Medical Center - Case Management Status: Full time Benefits Eligible: Yes Hou rs Per Week: 40 Schedule Details/Additional Information: Mon-Fri 0800-1630 With Weekend and Holiday rotation Pay Range: $38.20 - $57.30 INPATIENT CARE...

The On-Site Physician Advisor (OSPA) 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 On-Site 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...

Job Summary and Responsibilities As our Physician Advisor, you will promote evidence-based medical care and appropriate hospital resource utilization, facilitating communication across medical, nursing, care coordination, and administrative departments. Every day you will advocate for efficient patient care, remove barriers, and collaborate with attending physicians, bolstering the Department of Care Coordination's utilization and compliance efforts. To be successful, you need exceptional clinical acumen, strong communication, and a deep understanding of hospital operations/regulations. Your ability to influence, drive efficiency, and advocate will be paramount for optimizing care and resource allocation. Mitigate denials for payment from insurance payers by providing valid and effective secondary medical necessity reviews. Review and report performance measures and make recommendations to Departments and the Medical Executive Committee regarding opportunities...