Physician Advisor – Part Time, 1099, CA License Required

🔥 14 minutes ago

🏄 California – Remote

🏄 California – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

✨ Physician Advisor

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Processes second level reviews in compliance with Medicare/CMS: NCD, LCD and Milliman guidelines for Inpatient, Outpatient, Skilled Facilities Level of Care and Pharmacy. • Provides appropriate level of care classifications as well as continued stay reviews in compliance with CMS and Milliman guidelines. • Acts as a liaison between the medical staff, utilization review and 3rd party payers to effectively promote the appropriate levels of medical care. • Reviews the entire claim denial process, including Appeals and Grievances. • Serves as a Physician member of the utilization review team. • Works with Interdisciplinary Team to develop case management protocols and provide oversight for NP’s/PA’s training. • Acts as a Clinical Leader for HEDIS and STARS projects and serves as Clinical Advisor for HCC and RAF. • Serves as a Chairperson for Medical Quality Committee and provide Clinical Oversight for Chronic Disease Management programs and Quality Outcome. • Collaborates closely and provide assistance to Quality Director. • Works with Extensivists and Middle Level Practitioners (NP’s/PA’s) to reduce length of institutional stay, all cause readmission reduction and ER overutilization ensuring patients and therapeutic modalities. • Assists the organization to challenge physician practices in order to achieve the organization's clinical outcomes and quality goals.

🎯 Requirements

• Minimum of 3 years of experience in hospital-wide or skilled nursing facility position involving clinical care, quality management, utilization and case management, or medical staff governance required. • Completion of medical school and specialty residency (preferably in internal medicine) required. • Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. • Knowledge of current medical literature, research methodology, healthcare delivery systems, healthcare financial/reimbursement issues, and medical staff organizations. • Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Remote work options