? Apply in 3 Minutes: Physician Advisor – Onsite – Latrobe, PA Position Available In Allegheny, Pennsylvania

Job Description:

Optum is a global organization that delivers care, aided bytechnology to help millions of people live healthier lives. Thework you do with our team will directly improve health outcomes byconnecting people with the care, pharmacy benefits, data andresources they need to feel their best. Here, you will find aculture guided by diversity and inclusion, talented peers,comprehensive benefits and career development opportunities. Comemake an impact on the communities we serve as you help us advancehealth equity on a global scale. Join us to start Caring.

Connecting. Growing together. This position is for qualifiedphysicians seeking to enter the new and growing non-clinicalpractice specialty of Physician Advisor within a facility setting.

This position drives performance across our organization bycommunicating with hospital physicians and utilization managementstaff at client hospitals to champion best practices forevidence-based care and its documentation. The Physician Advisorwill be responsible for establishing, maintaining, andstrengthening the relationship with Optum client hospitals toappropriately optimize the use of Optum services. Training will beprovided by Optum. The Physician Advisor will join a team of Optumphysician advisors across the country.

Primary Scope of Service:

Although the Physician Advisor (PA) is employed by Optum, theintention is that the PA will become a key member of the clienthospital’s team charged with meeting the organization’s goals andobjectives for ensuring the effective, efficient utilization ofhealth care services. To this end, the PA will develop expertise onmatters regarding medical necessity, documentation best practicesand concurrent denial payor peer to peer interactions. PhysicianAdvisor will be required to work onsite at the facility M-F duringstandard facility business hours. The Physician Advisor will workclosely with medical staff, including house staff and activelyengage with hospital leadership and utilization management teamsrelated to both medical necessity status reviews and concurrentdenial reviews.

Primary Responsibilities:

• Conduct second levelmedical necessity/compliance status reviews for all payor types
• Requirement to gain and sustain a working knowledge of thetechnical systems to perform case reviews
• Meet with casemanagement, utilization management, social work, and otherhealthcare team members to discuss selected cases and makerecommendations regarding patient status through case reviews
• Interacting with medical staff to discuss medical necessity andconcurrent denial cases
• Act as a consultant for the medical staffregarding their decisions for the appropriate medical necessitystatus of hospitalized patients and supporting documentation
• Participate in the claims denial process by conducting peer to peerdiscussions with commercial payor medical directors for cases thathave been denied concurrently
• Coordinate with Optum/OPAS SubjectMatter Expert(s) for questions regarding federal, state and payorand regulatory requirements
• Serve as a physician member of theUtilization Review Committee, which may require non-clinicalmedical staff privileges application
• Provide focused case by caseeducation on utilization management topics (e.g., documentation) tothe medical and UM staff
• Develop and maintain a working knowledgeand understanding of OPAS proprietary guidance regarding clinicaldiagnoses and disease states.

Initial and ongoing training will beprovided by

OPAS Physician Advisor Will Not:

• Practice medicineduring the hours scheduled, which includes:
• Decision-making in apatient’s plan of care or discharge
• Write orders or prescriptions
• Provide on-call coverage
• Set hospital clinical oradministrative policies
• Supervise house staff or hospitalemployees
• 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 patientregarding appropriate treatment or course of medical care
• Reproduce or recreate Optum’s proprietary guidance for distributionor use in any client educational modules
• Execute any contracts onbehalf of Optum
• Post opinions related to medical necessity andpatient status in any publicly disseminated publication/websitewithout prior approval by appropriate Optum resources You’ll berewarded and recognized for your performance in an environment thatwill challenge you and give you clear direction on what it takes tosucceed in your role as well as provide development for other rolesyou may be interested in.

Required Qualifications:

• MD or DO
• Current, unrestricted medical license in Pennsylvania
• Demonstrated ability to build rapport with medical staff andhospital leadership
• Solid computer skills and working knowledgeof EMRs
• Receptive to feedback and coaching
• 3 years ofexperience in a hospital-based practice setting
• Solidcommunication and listening skills
• Ability to collaborate andpartner with multiple constituents (administrative, clinical,leadership, etc.)
• Organizational agility, assumes positiveintent, discovers the power pathways and circuits, navigates theorganizational maze to get things done All Physician Advisors havea Shared, Minimum Holiday coverage requirement which is coveredremotely.

Preferred Qualifications:

• Board Certified / Eligible
• Physician Advisor and or Utilization Review experience AtUnitedHealth Group, our mission is to help people live healthierlives and make the health system work better for everyone.

Webelieve everyone-of every race, gender, sexuality, age, locationand income-deserves the opportunity to live their healthiest life.

Today, however, there are still far too many barriers to goodhealth which are disproportionately experienced by people of color,historically marginalized groups and those with lower incomes. Weare committed to mitigating our impact on the environment andenabling and delivering equitable care that addresses healthdisparities and improves health outcomes — an enterprise priorityreflected in our mission. UnitedHealth Group is an Equal EmploymentOpportunity employer under applicable law and qualified applicantswill receive consideration for employment without regard to race,national origin, religion, age, color, sex, sexual orientation,gender identity, disability, or protected veteran status, or anyother characteristic protected by local, state, or federal laws,rules, or regulations. UnitedHealth Group is a drug

• freeworkplace.

Candidates are required to pass a drug test beforebeginning employment.