Physician Advisor I (Part-Time) Weekday/Weekends

Essential Duties & Responsibilities The essential functions include, but are not limited to the following:

• Provide clinical reviews in accordance with Managed Care and CMS Regulatory Requirements to:

o Assist with level of care and length of stay management on a case-by-case basis
o Assist with the denial management process
o Determine if professionally recognized standards of quality care are met
o Participate in the concurrent and retrospective appeal peer-review process"

• Provide feedback to internal and external partners regarding level of care, length of stay and quality issues, which may also include joining client meetings to review observations and trends in physician behavior and/or documentation. Recommend and request additional, more complete, medical record documentation. Provide guidance to internal and external staff regarding status issues and alternatives to acute level of care when such care is not warranted. Provide education to internal and external staff related to regulatory requirements, appropriate utilization, and alternative levels of care.

• Ensure appropriate documentation of patient care reviews, decisions, and other pertinent information. Be able to review cases with screening criteria, such as InterQual, MCG or other appropriate platforms. Develop and apply protocols related to evidence-based medicine and criteria.

• Work with internal and external Care Management staffs to ensure appropriate continuity of care and provide education to assist in reducing readmissions.

• Educate internal and external staff about ICD coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology to improve their understanding of severity, acuity, risk of mortality, and DRG assignments on their individual patient records.

• Provide insight into the development of the XSOLIS appeal operations and technology platform. Work with the Data Analytics team and assist in the enhancement of clinical analytics.

• Maintain current knowledge of federal, state, and payer regulatory and contract requirements.

• Additional functions as deemed appropriate and warranted.

• Full-time Physician Advisors are required to complete peer to peer reviews

Minimum Qualifications (Knowledge, Skills, and Abilities) Weekday (8a-8p) EDT Hours

• Graduate of an accredited medical school

• Additional education in quality and utilization management through continuing medical education programs and self-study

• 5 years recent experience in clinical practice

• Utilization management experience as a member of the UM oversight committee or past Physician Advisor experience preferred

• Licensed physician without restrictions

• Knowledge of federal, state, and payer regulatory and contract requirements

• Verbal and written communication skills

• Basic computer skills, including typing, navigating browsers, etc.

• MS Office Suite

• Professional demeanor and interpersonal skills

Working Environment and Travel Requirements

• Work is typically in a normal office administrative environment involving minimal exposure to physical risks.

• Position requires little to moderate physical activity. Mostly sedentary work exerting up to 10 pounds of force occasionally or a negligible amount of force to lift, carry, push, pull, or otherwise move objects. Work involves sitting most of the time, but may involve walking or standing for brief periods of time. No significant stooping is usually required.

XSOLIS is an equal opportunity employer that is committed to hiring based upon merit, skills, experience, and qualifications. We recognize the importance of an inclusive and diverse workforce that celebrates all individuals from all walks of life. We encourage everyone to apply regardless of gender identity, race, veteran status, age, sexual orientation, or any other protected class. All employees of XSOLIS fall under the same security role, which includes access to sensitive information, including proprietary data and PHI.