Clinical Services Consultant - Greensburg - beBeePhysicianAdvisor

    beBeePhysicianAdvisor
    beBeePhysicianAdvisor Greensburg

    6 days ago

    Job title: Onsite Physician Advisor

    Description

    Key Responsibilities

    • Conduct second-level medical necessity/compliance status reviews for all payor types, utilizing expertise to make informed decisions.
    • Meet with case management, utilization management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status through case reviews.
    • Interact with medical staff to discuss medical necessity and concurrent denial cases, providing guidance and support.
    • Act as a consultant for the medical staff regarding their decisions for the appropriate medical necessity status of hospitalized patients and supporting documentation, promoting high-quality care.
    • Participate in the claims denial process by conducting peer-to-peer discussions with commercial payor medical directors for cases that have been denied concurrently, driving resolution and improved outcomes.
    • Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application, contributing to the development of policies and procedures.

    Requirements

    • MD or DO degree from an accredited institution.
    • Current, unrestricted medical license in Pennsylvania.
    • 3+ years of experience in a hospital-based practice setting, demonstrating a track record of success.

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