A doctorate from an accredited medical or osteopathic school is required.
At least 3 years of experience in clinical practice is required.
Prior experience as a physician advisor or certification as a physician advisor is required.
Board certification in an applicable specialty is required.
Active medical staff privileges at the health system must be obtained within 90 days of hire.
Responsibilities
Provide medical necessity and patient status review.
Support inpatient, outpatient, and observation status.
Provide physician-to-physician consultation.
Conduct payer peer-to-peer reviews and appeals.
Escalate complex cases and discharge barriers, including multidisciplinary rounds.
Support post-acute care appeals.
Support length-of-stay and readmission management.
Engage and educate physicians regarding utilization management, documentation, and applicable CMS and payer requirements.
About Long Tail Health Solutions Inc.
Long Tail Health Solutions is a provider advocate, delivering a suite of technology-enabled services which discover and operationalize payer rules and behaviors to improve the visibility, execution, and outcomes of utilization review, case management, and revenue cycle functions.
Our mission is to optimize the financial performance and work-lives of healthcare providers by eliminating administrative waste with modern technology applied to long tail problems.
About the role
The Physician Advisor will provide physician advisor services designed to support and augment the health system’s utilization management, case management, revenue cycle, clinical documentation improvement, and related clinical operations.
What you'll do
·medical necessity and patient status review;
·inpatient, outpatient, and observation status support;
·physician-to-physician consultation;
·payer peer-to-peer reviews and appeals;
·complex case and discharge barrier escalation including MDRs;
·post-acute care appeals;
·length-of-stay and readmission management support;
·physician engagement and education regarding utilization management, documentation, and applicable CMS and
payer requirements.
·Other duties as assigned
Qualifications
1. Doctorate from an accredited Medical or Osteopathic School
2. 3 years of experience in a clinical practice
3. Prior experience in physician advisory OR certification as a physician advisor
4. Board Certified in applicable specialty
5. Active medical staff privileges at health system obtained within ninety (90) days of hire