Onsite Physician Advisor Latrobe PA
Company: UnitedHealth Group
Location: Jeannette
Posted on: September 17, 2023
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Job Description:
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. Here, you will find a
culture guided by diversity and inclusion, talented peers,
comprehensive benefits and career development opportunities. Come
make an impact on the communities we serve as you help us advance
health equity on a global scale. Join us to start Caring.
-Connecting. Growing together.
Onsite Physician Advisor opportunities in Latrobe, Philadelphia,
Greensburg and - PA,
This position is for qualified physicians seeking to enter the new
and growing non-clinical practice specialty of Physician Advisor.
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 DO
Current, unrestricted medical license in state of residence
Board certified/eligible
3+ years of post residency inpatient hospital experience
Solid computer skills and working knowledge of EMRs
**All Physician Advisors have a shared Minimum Holiday coverage
requirement which is covered remotely.
Preferred Qualifications:
Demonstrated ability to build rapport with medical staff and
hospital leadership
Utilization Management experience
Peer to peer 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.
UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: UnitedHealth Group, Penn Hills , Onsite Physician Advisor Latrobe PA, Healthcare , Jeannette, Pennsylvania
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