Temple Health – Temple University Health System
5001 - 10000 employees
🏥 Healthcare
💊 Pharmaceuticals
🧬 Biotechnology
Healthcare • Pharmaceuticals • Biotechnology
Temple Health is a comprehensive healthcare system associated with Temple University, offering a wide range of medical services including surgery, cancer care, and specialized treatments for various diseases. It operates multiple hospitals and healthcare locations, ensuring patient-centric care through highly qualified physicians and innovative medical practices. Temple Health is dedicated to advancing patient care through research, education, and a commitment to community well-being, recognized for its excellence in various medical fields and as a leader in lung transplants.
Physician Advisor
🔥 17 hours ago
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Temple Health – Temple University Health System
5001 - 10000 employees
🏥 Healthcare
💊 Pharmaceuticals
🧬 Biotechnology
Healthcare • Pharmaceuticals • Biotechnology
Temple Health is a comprehensive healthcare system associated with Temple University, offering a wide range of medical services including surgery, cancer care, and specialized treatments for various diseases. It operates multiple hospitals and healthcare locations, ensuring patient-centric care through highly qualified physicians and innovative medical practices. Temple Health is dedicated to advancing patient care through research, education, and a commitment to community well-being, recognized for its excellence in various medical fields and as a leader in lung transplants.
📋 Description
• Provide clinical expertise and guidance to the Clinical Analysis and Appeals team • Act as physician advisor for medical necessity appeals and Pennsylvania Medical Assistance (PAMA) utilization reviews • Serve as a physician resource for regulatory and revenue cycle denial and appeals processes • Perform utilization review for all PAMA cases and all UM denials and appeals
🎯 Requirements
• Doctorate Degree in Medicine or Osteopathic Medicine required • General experience and strong working knowledge of the InterQual Criteria Set and hospital reimbursement systems required • General experience in second- and third-level appeals processes, including direct experience as an expert witness, required • General experience in a managed care environment required • PA Medical Physician License required or PA Osteopathic Physician License required • Experience in an administrative leadership role preferred
🏖️ Benefits
• Equal Opportunity Employer/Veterans/Disabled • Healthy, safe and productive work environment
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