Onsite Physician Advisor - Latrobe, PA (Pittsburgh area)

The Physician Advisor (PA) is employed by Optum, the intention is that the PA will become a key member of the client hospital's 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 medical necessity, documentation best practices and concurrent denial payor peer to peer interactions. Physician Advisor will be required to work onsite at the facility M-F during standard facility business hours.

The Physician Advisor will work closely with medical staff, including house staff and actively engage with hospital leadership and utilization management teams related to both medical necessity status reviews and concurrent denial reviews.

Conduct second level medical necessity/compliance status reviews for all payor types

Meet with case management, utilization management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status through case reviews

Interacting with medical staff to discuss medical necessity and concurrent denial cases

Act as a consultant for the medical staff regarding their decisions for the appropriate medical necessity status of hospitalized patients and supporting documentation

Participate in the claims denial process by conducting peer to peer discussions with commercial payor medical directors for cases that have been denied concurrently

Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application

Required Qualifications:

MD or DO

Current, unrestricted medical license in Pennsylvania

3+ years of experience in a hospital-based practice setting