- R1 RCM (Detroit, MI)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Physician Advisor ** , you will help our client facilities ... this remote position. **Here's what you will experience working as a Physician Advisor :** + Addresses the following issues: authorization requested,… more
- University of Michigan (Ann Arbor, MI)
- Business Process Consultant/Strategic Advisor to the Chief Physician Executive (CPE) Apply Now **Job Summary** This position is a key member of the Office of the ... to advance CPE- and Triad-led initiatives. + Serve as a strategic advisor to the Chief Physician Executive regarding organizational alignment, communication… more
- Tenet Healthcare (Detroit, MI)
- …status and level of care per Tenet policy. Oversees submission of cases to Physician Advisor review to ensure timely referral, follow up and documentation. ... processes to prevent payer disputes, f) develops and provides physician education and feedback on hospital utilization, g) ensures...medical staff on actionable items * Implements and monitors physician "peer to peer" review process with payers to… more
- Sedgwick (Southfield, MI)
- …external support and arranges referrals to vendors for services such as physician advisor reviews, surveillance, independent medical evaluations, and functional ... plan.** **Carefully reviews and interprets detailed medical records-including attending physician statements, office notes, and operative reports-to assess whether… more
- Sedgwick (Southfield, MI)
- …and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability ... disability plan. + Reviews and analyzes complex medical information (ie attending physician statements, office notes, operative reports, etc.) to determine if the… more
- University of Michigan (Ann Arbor, MI)
- …appropriate utilization management venues + Conducts referrals and consultation with Physician Advisor **Professional Development** + Actively participates in ... a comprehensive plan of care for each patient/family in collaboration with the physician , social worker and all members of the interdisciplinary team in the… more
- Tenet Healthcare (Detroit, MI)
- …the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) care coordination, c) transition planning ... of care based on Medical Necessity process and submits case for Secondary Physician review per Tenet policy. Ensures timely communication of clinical data to payers… more
- Tenet Healthcare (Detroit, MI)
- …payors Performing accurate medical necessity screening and timely submission for Physician Advisor reviews Collaborating with payors, physicians, office staff ... level of care based on Medical Necessity and submits case for Secondary Physician review per Tenet policy Ensures timely communication and documentation of clinical… more
- CVS Health (Lansing, MI)
- …- Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus **Preferred ... Qualifications:** -Preferred Oklahoma residency -Health plan/payor Utilization Management / Review experience. -Managed Care experience. -Medicaid experience. **Education:** -M.D. or DO **Pay Range** The typical pay range for this role is: $174,070.00 -… more
- Tenet Healthcare (Commerce Township, MI)
- …include the following activities: a) accurate LOS screening and submission for Physician Advisor review, b) care coordination, c) transition planning assessment ... and reassessment, d) implementation or oversight of implementation of the transition plan, e) leading and facilitating multi-disciplinary patient care conferences, f) managing concurrent disputes, g) making appropriate referrals to other departments, h )… more