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Job Description
Join Optum as a Physician Advisor and make a meaningful impact on healthcare delivery by optimizing care practices and collaborating with medical staff. This role offers a unique opportunity to shape health outcomes in a growing non-clinical specialty.
Key Responsibilities
Conduct second level medical necessity/compliance status reviews for all payor types
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
Interact with medical staff to discuss medical necessity and concurrent denial cases
Act as a consultant for the medical staff regarding their decisions for appropriate medical necessity status
Participate in the claims denial process by conducting peer to peer discussions with commercial payor medical directors
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
Provide focused case by case education on utilization management topics to the medical and UM staff
Develop and maintain a working knowledge of OPAS proprietary guidance regarding clinical diagnoses and disease states
Required Qualifications
MD or DO
Current, unrestricted medical license in Maine
3+ years of experience in a hospital-based practice setting
Experience building rapport with medical staff and hospital leadership
Experience collaborating and partnering with multiple constituents (administrative, clinical, leadership, etc.)
Solid computer skills and working knowledge of EMRs
Preferred Qualifications
Board certified/eligible
Physician Advisor and or Utilization Review experience
Benefits & Perks
Comprehensive benefits packageIncentive and recognition programsEquity stock purchase401k contribution