Physician Advisor in Hobart, Indiana at Powers Health

The Physician Advisor will provide clinical expertise to support utilization management (UM) and quality initiatives within the healthcare setting. Key responsibilities include conducting clinical reviews, consulting with Physicians on patient status and resource use, collaborating with care management and health information management (HIM) to improve documentation and coding, and acting as a liaison with third-party payers for appeals and authorizations. The goal is to ensure accurate reimbursement, efficient use of hospital services, adherence to regulations, and ultimately, better patient care and outcomes.

Education & Experience Requirements:

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO). Graduate of an accredited residency program and is board eligible in American Board of Medical Specialties or equivalent board.
• Current and unlimited license to practice medicine in the State of Indiana.
• Maintain all necessary and customary narcotics and controlled substance numbers and licenses.
• Maintain active CPR certification.
• Minimum of 5 years of medical clinical practice or previous role as Physician Advisor.
• Knowledge of and ability to apply professional medical principles, procedures, and techniques.
• Excellent verbal and written communication skills to communicate effectively with other physicians, staff, patients, payors, etc.
• Effective ability to communicate recommendations or suggestions in a balanced way to the Physicians and staff.
• Experience in hospital process; i.e., utilization management, case management, clinical care protocols, and coding and billing with strong knowledge of regulatory requirements such as CMS and Joint Commission and payor guideline.
• Maintain concise, timely, and accurate confidential records of patients.
• Ability to analyze complex clinical and administrative data and provide actionable recommendations.
• Good time management skills. Strong decision making and practice skills.