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Physician Advisor (Part-Time)

4 hours, 17 minutes ago
United States
Part-time
Senior
Consultant
Operations
Apply Now
Xsolis

Xsolis

Xsolis is a healthcare AI vendor that automates decision-making for providers and payers using advanced technology like CORTEX, improving care efficiency.

IT Services
251-1K
Founded 2013
$75M raised
View All Jobs 4

Description

  • Provide clinical reviews in accordance with Managed Care and CMS regulatory requirements.
  • Assist with level of care and length of stay management on a case-by-case basis.
  • Support the denial management process and participate in concurrent and retrospective appeal peer review.
  • Determine whether professionally recognized standards of quality care are met.
  • Provide feedback to internal and external partners on level of care, length of stay, quality issues, and documentation.
  • Join client meetings to review observations and trends in physician behavior and documentation.
  • Recommend additional and more complete medical record documentation and guide staff on status issues and alternatives to acute care.
  • Document patient care reviews, decisions, and other pertinent information.
  • Review cases using screening criteria such as InterQual, MCG, or similar platforms.
  • Develop and apply protocols related to evidence-based medicine and criteria.
  • Work with care management teams to support continuity of care and reduce readmissions.
  • Educate staff on ICD coding guidelines, clinical terminology, regulatory requirements, utilization, and alternate levels of care.
  • Support the development of Xsolis appeal operations and technology platforms and assist with clinical analytics enhancements.
  • Maintain current knowledge of federal, state, payer regulatory, and contract requirements.
  • Complete peer-to-peer reviews for full-time physician advisor roles.

Requirements

  • Graduate of an accredited medical school.
  • 5 years of recent experience in clinical practice.
  • Additional education in quality and utilization management through continuing medical education programs and self-study.
  • Licensed physician without restrictions.
  • Utilization management experience as a member of a UM oversight committee or past physician advisor experience preferred.
  • Knowledge of federal, state, and payer regulatory and contract requirements.
  • Experience with physician documentation and electronic health records.
  • Verbal and written communication skills.
  • Basic computer skills, including typing and browser navigation.
  • MS Office Suite proficiency.
  • Professional demeanor and strong interpersonal skills.
  • Must successfully pass a background check.
  • Must be authorized to work in the United States on a full-time, permanent basis without visa sponsorship.

Benefits

  • Medical, dental, and vision insurance.
  • 401(k) company match.
  • Flexible paid time off.
  • Paid parental leave.
  • HSA/FSA options.
  • Educational reimbursement program.
  • Employer-paid EAP and mental health services.

Interested in this position?

Apply directly on the company website

Apply Now

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