Temporary Physician Advisor

Job Number: 1665

Workplace Type:

Position Title: Temporary Physician Advisor

External Description:

The Physician Advisor reports to the Plan Medical Director with accountably to Chief Health Officer. The Physician Advisor (PA) works with Senior Medical Officers, Regional Medical Officers, Extensivists, the Healthcare Services Team (Case managers, Social Workers, Utilization Managers to develop and implement methods to optimize use of Institutional and Outpatient services for all patients while also ensuring the quality of care provided. Through access to our web-based Portal, physician advisors will complete clinical reviews for medical necessity, treatment appropriateness and compliance.

 

General Duties/Responsibilities:

(May include but are not limited to)

• The Physician Advisor will be doing second level reviews in compliance with Medicare/CMS: NCD, LCD and Milliman guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care and Pharmacy.
• The Physician Advisor will provide appropriate level of care classifications as well as continued stay reviews in compliance with CMS and Milliman guidelines.
• The Physician Advisor will act as a liaison between the medical staff, utilization review and 3rd party payers to effectively promote the appropriate levels of medical care.
• The Physician Advisor will be reviewing the entire claim denial process, including Appeals and Grievances.
• The Physician Advisor will serve as a Physician member of the utilization review team.
• PA works with Interdisciplinary Team to develop case management protocols and provide oversight for NP’s/PA’s training.
• PA acts as a Clinical Leader for HEDIS and STARS projects and serves as Clinical Advisor for HCC and RAF.
• PA serves as a Chair person for Medical Quality Committee and provide Clinical Oversight for Chronic Disease Management programs and Quality Outcome.
• Collaborates closely and provide assistance to Quality Director.
• PA works with Extensivists and Middle Level Practitioners (NP’s/PA’s) to reduce length of institutional stay, all cause readmission reduction and ER overutilization ensuring patients and therapeutic modalities.
• The Physician Advisor assists the organization to challenge physician practices in order to achieve the organization's clinical outcomes and quality goals.

 

Supervisory Responsibilities:

NA

 

Minimum Requirements:

 

1. Minimum Experience:
2. 3-5 years of experience in hospital-wide or skilled nursing facility position involving clinical care, quality management, utilization and case management, or medical staff governance required. Experience as a Physician Advisor a plus

1. Education/Licensure:
2. Completion of medical school and specialty residency (preferably in internal medicine) required. Subspecialty or other post-residency fellowship and board certification preferred. Applicants must have current, non-restricted licensure as required for clinical practice in the state of California.
3. Other:
4. Ability to build rapport with medical staff and management leadership to obtain necessary approvals of new strategies for utilization management.
5. Knowledge of current medical literature, research methodology, healthcare delivery systems, healthcare financial/reimbursement issues, and medical staff organizations.
6. Dedication to the delivery of high-quality, cost-effective, efficient patient care services
7. Excellent communication skills
8. Must have great attention to detail as well as taking pride in being a good team member and communicate effectively with medical staff.
9. Mon- Fri 8- 5PM
10. Flexible schedule

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Temporary Physician Advisor

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].