Physician Advisor - Onsite - Latrobe, PA

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.This position is for qualified physicians seeking to enter the new and growing non-clinical practice specialty of Physician Advisor within a facility setting. 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 Optum 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 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 medical necessity, documentation best practices and concurrent denial payor peer to peer interactions. Physician Advisor will be required to work onsite at the facility M-F during standard facility business hours.The Physician Advisor will work closely with medical staff, including house staff and actively engage with hospital leadership and utilization management teams related to both medical necessity status reviews and concurrent denial reviews.Primary Responsibilities:

Conduct second level medical necessity/compliance status reviews for all payor types

Requirement to gain and sustain a working knowledge of the technical systems to perform case reviews

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

Interacting with medical staff to discuss medical necessity and concurrent denial cases

Act as a consultant for the medical staff regarding their decisions for the appropriate medical necessity status of hospitalized patients and supporting documentation

Participate in the claims denial process by conducting peer to peer discussions with commercial payor medical directors for cases that have been denied concurrently

Coordinate with Optum/OPAS Subject Matter Expert(s) for questions regarding federal, state and payor and regulatory requirements

Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application

Provide focused case by case education on utilization management topics (e.g., documentation) to the medical and UM staff

Develop and maintain a working knowledge and understanding of OPAS proprietary guidance regarding clinical diagnoses and disease states. Initial and ongoing training will be provided by OPAS

Physician Advisor Will Not:

Practice medicine during the hours scheduled, which includes:

Decision-making in a patient’s plan of care or discharge

Write orders or prescriptions

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)

Participate in clinical research or clinical trials

Participate in the medical decision making of any hospital patient regarding appropriate treatment or course of medical care

Reproduce or recreate Optum’s proprietary guidance for distribution or use in any client educational modules

Execute any contracts on behalf of Optum

Post opinions related to medical necessity and patient status in any publicly disseminated publication/website without prior approval by appropriate Optum resources

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:

MD or DO

Current, unrestricted medical license in Pennsylvania

Demonstrated ability to build rapport with medical staff and hospital leadership

Solid computer skills and working knowledge of EMRs

Receptive to feedback and coaching

3+ years of experience in a hospital-based practice setting

Solid communication and listening skills

Ability to collaborate and partner with multiple constituents (administrative, clinical, leadership, etc.)

Organizational agility, assumes positive intent, discovers the power pathways and circuits, navigates the organizational maze to get things done All Physician Advisors have a Shared, Minimum Holiday coverage requirement which is covered remotely.

Preferred Qualifications:

Board Certified / Eligible

Physician Advisor and or Utilization Review experience

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.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.