Physician Advisor - Onsite - Latrobe, PA

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This position is for qualified physicians seeking to enter the new and growing non-clinical practice specialty of Physician Advisor within a facility setting. 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.

Primary Responsibilities:

• Conduct second level medical necessity/compliance status reviews for all payor types
• Requirement to gain and sustain a working knowledge of the technical systems to perform case reviews
• 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
• Coordinate with Optum/OPAS Subject Matter Expert(s) for questions regarding federal, state and payor and regulatory requirements
• Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application
• Provide focused case by case education on utilization management topics (e.g., documentation) to the medical and UM staff
• Develop and maintain a working knowledge and understanding of OPAS proprietary guidance regarding clinical diagnoses and disease states. Initial and ongoing training will be provided by OPAS

Required Qualifications:

• MD or DO
• Current, unrestricted medical license in Pennsylvania
• Demonstrated ability to build rapport with medical staff and hospital leadership
• Solid computer skills and working knowledge of EMRs
• Receptive to feedback and coaching
• 3+ years of experience in a hospital-based practice setting
• Solid communication and listening skills
• Ability to collaborate and partner with multiple constituents (administrative, clinical, leadership, etc.)
• Organizational agility, assumes positive intent, discovers the power pathways and circuits, navigates the organizational maze to get things done ** All Physician Advisors have a Shared, Minimum Holiday coverage requirement which is covered remotely.

Preferred Qualifications:

• Board Certified / Eligible
• Physician Advisor and or Utilization Review experience