Physician Advisor (NE)

The Opportunity

The Physician Advisor provides leadership for efficiently managing resource and utilization to deliver quality cost-effective care in the most appropriate setting. Works closely with the medical staff leadership, the entire medical staff, including resident physician house staff in all areas of resource/utilization management to develop and implement methods to optimize use of hospital services for all patients.

• Works with hospital leadership in developing care management protocols with physicians and others to optimize efficient management of resources, ensuring patients are in the appropriate level of care.
• Supports documentation, coding improvements and compliance.
• Performs Peer to Peer reviews, Short Stay Reviews, Extended Observation.
• Provides for medical staff education and training as required.
• Provides periodic reports to Board, MEC and Joint Conference as deemed necessary.

Job Functions

• Status determinations for hospitalized patients.
• Perform peer to peers with payors' medical directors.
• Short inpatient stay reviews.
• Review observation patients daily.
• Build relationship with medical staff and leadership to get their buy-in with UM issues.
• Attend UM Committees as subject matter expert.
• Aid with denials and appeals as appropriate.
• Educate medical staff on UM topics.
• Parellel with UR nurses, IA staff, and Case Management to maintain and improve upon the UM process.
• Track denial trends to assist the team evolve to meet new payor challenges.

Employment Qualifications

• MD/DO Physician (MUST have).
• This position pays between $198,000- $297,000 based on relevant experience.

Company Information

• O.N.E Purpose: Customer Obsession, Embracing New Ideas, Striving for Excellence.
• Join An Award-winning Company: Five-time winner of “Best in KLAS”, 2020-2022, 2024-2025 Black Book Research's Top Revenue Cycle Management Outsourcing Solution, 2021-2024 22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle, 2019-2024 Leader in Everest Group's RCM Operations PEAK Matrix Assessment, 2024 Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance, 2020, 2022-2023 Energage Top Workplaces USA, 2022-2024 Fortune Media Best Workplaces in Healthcare, 2024 Monster Top Workplace for Remote Work, 2024 Great Place to Work certified, 2023-2024.
• Our Culture: Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
• Growth: We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.
• Recognition: We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.
• Innovation: Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.
• Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law.
• Compensation: Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position.

Employment Disclaimers

This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role’s range. Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories. Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.