Physician Advisor, Part-Time

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Xsolis

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2013

🏥 Healthcare

☁️ SaaS

🤖 Artificial Intelligence

💰 $75M Private Equity Round - Xsolis on 2021-06

Healthcare • SaaS • Artificial Intelligence

Xsolis is an AI-driven healthcare technology company that builds SaaS solutions to improve collaboration between providers and payers and make medical necessity and utilization decisions more objective and efficient. Its proprietary Dragonfly® platform applies real-time predictive analytics, natural language processing, and machine learning to assign continuous medical necessity scores and anticipate level-of-care for every patient, supporting utilization management, denial prevention, and revenue cycle workflows. Headquartered in Franklin, Tennessee, Xsolis emphasizes a human-centered approach and has been recognized on the Inc. 5000 and Deloitte Technology Fast 500 lists.

📋 Description

• Provide clinical reviews in accordance with Managed Care and CMS Regulatory Requirements • Assist with level of care and length of stay management on a case-by-case basis • Assist with the denial management process • Determine whether professionally recognized standards of quality care are met • Participate in concurrent and retrospective appeal peer-review processes • Provide feedback to internal and external partners regarding level of care, length of stay, quality issues, physician behavior, and documentation • Recommend and request additional medical record documentation • Guide staff regarding status issues and alternatives to acute care • Educate staff on regulatory requirements, appropriate utilization, and alternative levels of care • Document patient care reviews, decisions, and pertinent information • Review cases using screening criteria such as InterQual and MCG • Develop and apply evidence-based medicine and utilization protocols • Work with Care Management staff to support continuity of care and reduce readmissions • Educate staff on ICD coding guidelines, clinical terminology, severity, acuity, mortality risk, and DRG assignments • Provide insight into XSOLIS appeal operations and technology platform development • Work with the Data Analytics team to enhance clinical analytics • Maintain current knowledge of federal, state, payer regulatory, and contract requirements • Complete peer-to-peer reviews if working full time • Serve as a single contributor with no direct reports

🎯 Requirements

• Graduate of an accredited medical school • Additional education in quality and utilization management through continuing medical education programs and self-study • 5 years of recent experience in clinical practice • Licensed physician without restrictions • Knowledge of federal, state, payer regulatory, and contract requirements • Utilization management or physician advisor experience preferred • Verbal and written communication skills • Basic computer skills, including typing and browser navigation • Proficiency with MS Office Suite • Professional demeanor and interpersonal skills • Must pass a background check • Must already be authorized to work in the United States on a full-time, permanent basis without current or future visa sponsorship

🏖️ Benefits

• Medical/Dental/Vision insurance • 401K company match • Flexible Paid Time Off • Paid parental leave • HSA/FSA options • Educational reimbursement program • Employer-paid EAP & Mental Health services