Physician Advisor

🕒 3 days ago

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Ensemble Health Partners

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Private Equity Round on 2022-03

Consulting • Insurance • Logistics

Ensemble Health Partners is a leading provider of revenue cycle management (RCM) services for healthcare organizations. They offer an end-to-end RCM solution that helps hospitals, health systems, and affiliated physician groups optimize their revenue cycles, reduce denials and underpayments, and enhance patient experiences using a combination of expert management and advanced technology. Ensemble Health Partners leverages certified operators and AI to deliver consistent results, improve collections, and support future growth for healthcare providers. They are recognized for their robust client partnerships and commitment to delivering reliable revenue lift and cost savings for their clients.

📋 Description

• Provide leadership for efficiently managing resource utilization and delivering quality, cost-effective care in the appropriate setting • Work with medical staff leadership, physicians, and resident physician house staff on resource and utilization management • Develop and implement methods to optimize hospital service utilization • Develop care management protocols with hospital leadership and physicians • Ensure patients are placed in the appropriate level of care • Support documentation, coding improvements, and compliance • Perform peer-to-peer reviews with payors’ medical directors • Conduct short inpatient stay reviews and daily observation patient reviews • Build relationships with medical staff and leadership to gain buy-in on utilization management issues • Attend utilization management committees as a subject matter expert • Assist with denials and appeals • Educate medical staff on utilization management topics • Partner with UR nurses, IA staff, and Case Management to maintain and improve the utilization management process • Track denial trends to help the team address evolving payor challenges • Provide periodic reports to the Board, MEC, and Joint Conference as necessary • Lead and develop teams through coaching, delegation, communication, and program/project management

🎯 Requirements

• MD/DO Physician (MUST have) • Physician qualification and licensure as applicable to the role • Ability to manage hospital resource utilization and utilization management processes • Knowledge of status determinations, peer-to-peer reviews, short inpatient stays, and observation reviews • Ability to support documentation, coding improvements, and compliance • Ability to assist with denials and appeals • Ability to educate medical staff on utilization management topics • Ability to collaborate with UR nurses, IA staff, Case Management, medical staff, and hospital leadership • Leadership decision-making, coaching, delegation, team leadership, executive communication, and program/project management skills

🏖️ Benefits

• Comprehensive benefits package including healthcare, time off, retirement, and well-being programs • Professional certification relevant to the associate's field • Tuition reimbursement • Quarterly and annual incentive programs for employees • Work-life flexibility • Professional development and growth opportunities