Website UnitedHealth Group
Position Description
Optum360 Physician Advisor Solutions, a part of UnitedHealth Group has a salaried Full time opportunity for an Onsite Physician Advisor in Norman OK.
As a Physician Advisor, you will serve as a liaison between the clinical staff and hospital administration, working closely with case management (length of stay, patient status), medical necessity, Medicare regulations, claim denials and documentation. This is an onsite role, Monday through Friday and offers:
- Improved work/life balance
- 100% non-care delivery role
- Pathway for a different career in healthcare, still involving patient care, quality and safety
- Full support and training from Optum360 Physician Advisor Solutions -the industry-leading expert
- Fast-growing and evolving industry
- Opportunity to positively impact other physicians
- Continued development and application of your clinical skills
Expanding access to affordable, high quality healthcare starts here. This is where some of the most innovative ideas in healthcare are created every day. This is where bold people with big ideas are writing the next chapter in healthcare. You’ll have the most opportunities to grow and develop! This is the place to do
your life’s best work.(sm)
This position is for qualified physicians seeking to enter the new and growing non-clinical practice specialty of Physician Advisor with a career trajectory towards a provider or payor medical director and beyond. This position drives performance across our organization by communicating with hospital physicians and utilization management staff at client hospitals to champion best practices for evidence-based care and its documentation. The Physician Advisor will be responsible for establishing, maintaining, and strengthening the relationship with Optum client hospitals to appropriately optimize the use of Optum services.
Training will be provided by Optum. The Physician Advisor will join a team of on-site physician advisors across the country.
Primary Scope of Service:
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. To this end, the PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial management, and compliance with governmental regulations and commercial insurance contracts.
The Physician Advisor will work closely with the medical staff, including house staff, hospital leadership, and all utilization management (UM) personnel to develop and implement methods to optimize the use of hospital services. This includes care management processes that insure patients are in the appropriate level of care with supporting documentation for regulatory compliance and accurate coding.
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
- Interacting 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:
o Decision-making in a patient’s plan of care or discharge
o Write orders or prescriptions
o 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)
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:
- Board Certified / Eligible
- Minimum of 3 years of experience in a hospital-based practice setting
As health care continues to change and evolve, so do your opportunities to join a superb team who are working every day to make health care work better.
Optum Physician Advisory Solutions is part of Optum and the growing family of UnitedHealth Group companies. We help smooth out the interplay between each hospital client and the various payers. How? We serve as an expert partner on issues that confront hospitals every day involving medical necessity, reimbursement, coding and documentation. And while that’s a mouthful, it makes us proud to say that we rise to a level of professionalism and quality that can totally invigorate your career.
Join us today and you’ll soon be doing your life’s best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: MD, DO, healthcare, clinical,
hospital leadership, Norman, Oklahoma City, OK, Oklahoma,
Physician Advisor, Medical Director, Physician Utilization Review,
Physician, Hospital, Clinician, Doctor, Managed Care, Utilization Review, UR, UM, Utilization Management, CDI, Hospitalist, Case Review, Medical Necessity, peer to peer, EMR, EHR, LOS, denials, Hospital Administration, Utilization Review Committee
Job Details
- Requisition Number831713
- Job TitleOnsite Physician Advisor Norman OK
- Job FamilyMedical and Clinical Operations
- Business SegmentOptumInsight
Job Location Information
- Norman, OK
United States
North America - Other LocationsOklahoma City, OK
Additional Job Detail Information
- Employee StatusRegular
- ScheduleFull-time
- Job LevelIndividual Contributor
- ShiftDay Job
- TravelNo
- Telecommuter PositionNo
- Overtime StatusExempt