Physician Advisor - MedStar Multisite
$250,000–$250,000 year
HybridMaryland, United States
Job Summary
Review patient status, medical necessity, and level of care to optimize resource use and reduce length of stay. Lead clinical denial interventions, root cause determinations, and upstream process improvement initiatives while managing concurrent and retrospective denials through peer-to-peer discussions with payers. Drive length of stay improvements in collaboration with case management and hospital stakeholders. Provide education to physicians on regulatory requirements, appropriate utilization, and alternative care levels. Participate in Interdisciplinary Rounds and ensure regulatory compliance for Utilization Management and discharge planning processes.
Required Qualifications
- Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.)
- Board Certification (Internal Medicine or Emergency Medicine)
- Minimum 5 years of direct clinical practice
- Current medical license in the practicing state
- Board Certified
- Strong knowledge of case management, utilization review, regulatory standards, denials management, observation medicine, and length of stay
- Familiarity with MCG and InterQual clinical criteria
Desired Qualifications
- Hospital based experience
- Previous experience as physician advisor
- Additional certification in healthcare administration, business, or physician advisory
- ACPAP-C or ABQUARP certification in Physician Advisory (or willingness to obtain within 1 year of hire)
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