Physician Advisor II - Remote | WFH

We are a leading healthcare organization formed by the merger of Catholic Health Initiatives (CHI) and Dignity Health. Committed to serving communities across the U.S., we operate over 700 care sites, including clinics, hospitals, home-based care, and virtual services. Our mission is to bring compassion, care, and protection to individuals and families in need. Join us in our endeavor to build healthier communities, advocate for the vulnerable, and innovate healthcare delivery.

Responsibilities

This position is fully remote, and candidates licensed in Texas are preferred. However, applicants licensed in other states will also be considered for future opportunities.

As a Utilization Management Physician Advisor II, you will play a pivotal role in conducting clinical case reviews to ensure quality patient care and efficient healthcare utilization. Collaborating with case management teams and healthcare professionals, you will provide recommendations for patient care and engage in discussions with medical staff and third-party payers. Serving as a consultant and resource for attending physicians, you will contribute to the optimization of healthcare resources and compliance with regulatory standards.

Key Responsibilities

Conduct comprehensive medical record reviews to assess medical necessity, discharge planning, and care management quality.

Utilize expertise in healthcare coding systems and payment methodologies to determine severity of illness and communicate effectively with treating physicians.

Act as a liaison between national care management teams, medical staff, and executives to promote physician cooperation and documentation accuracy.

Provide education and communication regarding internal physician advisor services to enhance medical staff understanding and engagement.

Collaborate with facility leadership to communicate program outcomes and support process improvement efforts.

Participate in various facility committee meetings and engage in peer-to-peer discussions with payers as needed.

Facilitate client profiles, clinical service utilization, and revenue management activities in coordination with care management staff.

Qualifications

MD or DO degree required.

Minimum 3 years of experience as a Physician Advisor and 5 years of clinical practice experience.

Experience in peer-to-peer reviews and utilization management.

Unrestricted license in one or more states, Texas preferred.

Broad-based knowledge of clinical practice and CMS regulations.

Education in quality and utilization management.

Excellent written and verbal communication skills.

Benefits

While you contribute to the healthcare industry, we prioritize your well-being with comprehensive benefits, including:

Medical/Dental/Vision coverage

Flexible Spending Account (FSA) and Dependent Care Spending Account

Life Insurance and Short-/Long-term Disability coverage

401k match

Paid Time Off

Wellness Program

Tuition Reimbursement

Accidental and Critical Illness Insurance

Identity Theft Protection

Employee Assistance Program, and more!

Join our team and make a difference in healthcare while enjoying a supportive work environment and competitive benefits package.

Employment Type: Full-Time