Onsite Physician Advisor East Chicago

East Chicago, IN


Primary Responsibilities:

  • Conduct medical necessity reviews of cases referred by case management to ensure medical necessity and regulatory requirements are met for level of care
  • Meet with case management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status
  • Interact with medical staff and medical directors of third-party payers to discuss the needs of patients and alternative levels of care
  • Act as a consultant for the medical staff regarding their decisions for the appropriate level of care of hospitalized patients and supporting documentation
  • Participate in the claims denial process, including appeals
  • Review of utilization data to ensure hospital objectives for quality patient care
  • Act as a resource for the medical staff regarding federal, state, and payer regulatory, quality, and contract requirements
  • Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application
  • Provide education on utilization management topics (e.g., documentation) to the medical and UM staffs

Required Qualifications:

· MD or DO

· Current, unrestricted medical license in state of residence

· Demonstrated ability to build rapport with medical staff and hospital leadership

· Strong computer skills and working knowledge of EMRs

Preferred Qualifications:

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

· Board Certified / Eligible

Posted September 2, 2021