Onsite Physician Advisor in Lewiston ME

Lewiston, ME

full-time
Inpatient and outpatient

Although the Physician Advisor (PA) is employed by Optum, the intention is that the PA will become a key member of the client hospital’s leadership team charged with meeting the organization’s goals and objectives for ensuring the effective, efficient utilization of health care services.

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

Physician Advisor Will Not:

  • Practice medicine during the hours scheduled, which includes:
    • Decision-making in a patient’s plan of care or discharge
    • Write orders or prescriptions
    • Provide on-call coverage
  • Set hospital clinical or administrative policies
  • Supervise house staff or hospital employees
  • Participate in any type of peer review (e.g., Quality, M&M)

Preferred Qualifications:

  • 3+ years of experience in a hospital-based practice setting
  • Board Certified / Eligible


Posted March 5, 2021