Expandingaccess to affordable, high quality healthcare starts here. This is where someof the most innovative ideas in healthcare are created every day. This is wherebold people with big ideas are writing the next chapter in healthcare. You'llhave the most opportunities to grow and develop! This is the place to do yourlife's best work.(sm)
This position is for qualified physicians seeking to enter the new and growingnon-clinical practice specialty of Physician Advisor with a career trajectorytowards a provider or payor medical director and beyond. This position drivesperformance across our organization by communicating with hospital physiciansand utilization management staff at client hospitals to champion best practicesfor evidence-based care and its documentation. The Physician Advisor will beresponsible for establishing, maintaining, and strengthening the relationshipwith Optum client hospitals to appropriately optimize the use of Optumservices.
Training will be provided by Optum. The Physician Advisor will join a team ofon-site physician advisors across the country.
Primary Scope of Service:
Although the Physician Advisor (PA) is employed by Optum, the intention is thatthe PA will become a key member of the client hospital's leadership teamcharged with meeting the organization's goals and objectives for ensuring theeffective, efficient utilization of health care services. To this end, the PAwill develop expertise on matters regarding physician practice patterns, over-and under-utilization of resources, medical necessity, documentation bestpractices, level of care progression, denial management, and compliance withgovernmental regulations and commercial insurance contracts.
The Physician Advisor will work closely with the medical staff, including housestaff, hospital leadership, and all utilization management (UM) personnel todevelop and implement methods to optimize the use of hospital services. Thisincludes care management processes that insure patients are in the appropriate levelof care with supporting documentation for regulatory compliance and accuratecoding.
* Conductmedical necessity reviews of cases referred by case management to ensuremedical necessity and regulatory requirements are met for level of care
* Meet withcase management, social work, and other healthcare team members to discussselected cases and make recommendations regarding patient status
* Interactwith medical staff and medical directors of third-party payers to discuss the needs of patients and alternative levels of care
* Act as aconsultant for the medical staff regarding their decisions for the appropriatelevel of care of hospitalized patients and supporting documentation
* Participatein the claims denial process, including appeals
* Review ofutilization data to ensure hospital objectives for quality patient care
* Act as aresource for the medical staff regarding federal, state, and payer regulatory,quality, and contract requirements
* Serve asa physician member of the Utilization Review Committee, which may requirenon-clinical medical staff privileges application
* Provideeducation on utilization management topics (e.g., documentation) to the medicaland UM staffs
PhysicianAdvisor Will Not:
* Practicemedicine 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
* Sethospital clinical or administrative policies
* Supervisehouse staff or hospital employees
* Participatein any type of peer review (e.g., Quality, M&M)
* MD or DO
* Current, unrestrictedmedical license in state of residence
* Demonstrated abilityto build rapport with medical staff and hospital leadership
* Strong computerskills and working knowledge of EMRs
* 3+ years ofexperience in a hospital-based practice setting
* Board Certified /Eligible
Careers with Optum. Here's the idea. We built an entire organization around onegiant objective; make health care work better for everyone. So when it comes tohow we use the world's large accumulation of health-related information, orguide health and lifestyle choices or manage pharmacy benefits for millions,our first goal is to leap beyond the status quo and uncover new ways to serve.Optum, part of the UnitedHealth Group family of businesses, brings togethersome of the greatest minds and most advanced ideas on where health care has togo in order to reach its fullest potential. For you, that means working on highperformance teams against sophisticated challenges that matter. Optum,incredible ideas in one incredible company and a singular opportunity to do yourlife's best work.(sm)
Diversity creates a healthier atmosphere:UnitedHealth Group is an Equal Employment Opportunity/Affirmative Actionemployer and all qualified applicants will receive consideration for employmentwithout regard to race, color, religion, sex, age, national origin, protectedveteran status, disability status, sexual orientation, gender identity orexpression, marital status, genetic information, or any other characteristicprotected by law.
UnitedHealth Group is a drug-free workplace.Candidates are required to pass a drug test before beginning employment.
Job Keywords: Physician Advisor, MD, DO, Hospital,Healthcare, Health Care, EMR, Walnut Creek, Concord, San Francisco, CA,California