Per Diem Physician Advisor

The Physician Advisor will advise on the clinical management of cases referred by case management, clinicians, and the care team to ensure appropriate level of care and compliance with regulations. Responsibilities include educating physicians and care teams on insurance regulations for medical conditions, identifying cases for inpatient level of care and initiating peer-to-peer discussions with payers, and documenting the outcomes of these discussions. The role involves reviewing high-risk non-commercial cases, outreaching to clinicians to discuss these cases and documentation, and addressing issues related to observation length of stay, clinical utilization trends, discharge barriers, and service delays. The Physician Advisor will also determine appropriate cases for appeal, review Medicare/Medicaid RAC denials for written appeals, follow up on appeal cases, and participate in subsequent appeals activities. Additionally, they will assist in the development and implementation of protocols and admission criteria.