Physician Advisor - Concurrent Appeals & Denials - Remote Job Delaware USA,Doctor/Physician

Improve the lives of others while Caring. Connecting. Growing together.

Job Description
- Physician Advisor
- Concurrent Appeals & Denials
- Remote (2381392)

Physician Advisor
- Concurrent Appeals & Denials
- Remote - 2381392

Optum Insightis improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payors, and ultimately consumers. Our deepexpertisein the industry and innovative technology empower us to help organizations reduce costs while improving risk management,quality and revenue growth. Ready to help us deliver results that improve lives?

Join us to start
Caring. Connecting. Growing together.

In this Physician Advisor role, you will partner with providers, case managers, and payors to conduct medical necessity reviews, facilitate peer-to-peer discussions, manage appeals, and ensure appropriate patient status determinations. This position offers the opportunity to leverage your clinical expertise to support quality outcomes, compliance, and cost-effective care across client health systems.

Basic Functions:

To provide medical necessity and compliance reviews for our client hospitals
To perform concurrent peer to peer reviews with payor medical directors

To perform written and verbal appeals

Hours

Coverage spans from 8am-3am EST with set schedules based on business needs providing adequate staffing for all shifts. There is a shared responsibility for weekend and Holiday coverage by all Physician Advisors.

You’llenjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Promote efficient and effective clinical care of hospitalized patients delivered in a timely, appropriate and cost-effective fashion as guided by evidenced based medicine and regulatory requirements via review of clinical documentation, collaborative telephonic communication and other interactions with hospital client Case Managers and Attending Physicians
Promote payor and provider adherence to all applicable regulatory standards and CMS policy regarding inpatient admissions, observation/outpatient status, and the appropriate status for continued hospital stays
Meet Optum performance and quality metrics while incorporating feedback from quality improvement reports and providing exceptional customer service
Function as a vital aspect of a team consisting of other Physician Advisors, Nurses, Administrative Assistants, Clinical Relationship Managers, and Team Leaders with prompt responses to requests for assistance from any members of that team
Performing all applicable administrative tasks, staying abreast of internal policies/procedures, regulatory changes and updates within the business segment, and completing and passing mandatory UHG and Optum Physician Advisor Service education modules
Make engagement an area of focus and priority with commitment to the organization, colleagues and team members, as well as our clients
Performing concurrent peer-to-peer discussions with payor medical directors on behalf of client hospitals
Performing written and verbal appeals on behalf of client hospitals

You’llbe 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 asprovidedevelopment for other roles you may be interested in.

Required Qualifications:

Licensed Physician (MD or DO) with a current, active, unrestricted Medical License in the U.S.
Current Board Certification
3+ years of experience in a hospital-based practice setting
Demonstrated computer proficiency (i.e., navigating multiple platforms simultaneously, proficient typing skills, MS Office Suite, etc.)
Demonstrated…