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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 insure patients are in the appropriate level of care with supporting documentation for regulatory compliance and accurate coding.
- 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.
- MD or DO
- Current, unrestricted medical license in state of residence
- Demonstrated ability to build rapport with medical staff and hospital leadership
- Proven computer skills and working knowledge of EMRs
- You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations
- Employees 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
- 3+ years of experience in a hospital-based practice setting
- Board Certified / Eligible
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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.
Job Keywords: Physician Advisor, MD, DO, Hospital, Healthcare, Health Care, EMR, Milford, MA, Boston, Worester, Massachusetts, Utilization review, UR, CDI