Temporary Physician Advisor
Location: Orange, California US
Job Number: 1665
Position Title: Temporary Physician Advisor
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.
(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.
- Minimum Experience:
- 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
- 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.
- Ability to build rapport with medical staff and management leadership to obtain necessary approvals of new strategies for utilization management.
- Knowledge of current medical literature, research methodology, healthcare delivery systems, healthcare financial/reimbursement issues, and medical staff organizations.
- Dedication to the delivery of high-quality, cost-effective, efficient patient care services
- Excellent communication skills
- Must have great attention to detail as well as taking pride in being a good team member and communicate effectively with medical staff.
- Mon- Fri 8- 5PM
- 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.
- 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.
- 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.
Location City: Orange
Location State: California
Community / Marketing Title: Temporary Physician Advisor
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact firstname.lastname@example.org.