Physician Advisor - Concurrent Appeals & Denials - Remote

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.  

In this Physician Advisor role, you will partner with providers, case managers, and payors to conduct medical necessity reviews, facilitate peer-to-peer discussions, manage appeals, and ensure appropriate patient status determinations. This position offers the opportunity to leverage your clinical expertise to support quality outcomes, compliance, and cost-effective care across client health systems.

Basic Functions: 

• To provide medical necessity and compliance reviews for our client hospitals
• To perform concurrent peer to peer reviews with payor medical directors 

• To perform written and verbal appeals

   

Hours 
Coverage spans from 8am-3am EST with set schedules based on business needs providing adequate staffing for all shifts. There is a shared responsibility for weekend and Holiday coverage by all Physician Advisors.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:  

• Promote efficient and effective clinical care of hospitalized patients delivered in a timely, appropriate and cost-effective fashion as guided by evidenced based medicine and regulatory requirements via review of clinical documentation, collaborative telephonic communication and other interactions with hospital client Case Managers and Attending Physicians
• Promote payor and provider adherence to all applicable regulatory standards and CMS policy regarding inpatient admissions, observation/outpatient status, and the appropriate status for continued hospital stays
• Meet Optum performance and quality metrics while incorporating feedback from quality improvement reports and providing exceptional customer service
  Function as a vital aspect of a team consisting of other Physician Advisors, Nurses, Administrative Assistants, Clinical Relationship Managers, and Team Leaders with prompt responses to requests for assistance from any members of that team
• Performing all applicable administrative tasks, staying abreast of internal policies/procedures, regulatory changes and updates within the business segment, and completing and passing mandatory UHG and Optum Physician Advisor Service education modules
• Make engagement an area of focus and priority with commitment to the organization, colleagues and team members, as well as our clients
• Performing concurrent peer-to-peer discussions with payor medical directors on behalf of client hospitals
• Performing written and verbal appeals on behalf of client hospitals

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications: 

• Licensed Physician (MD or DO) with a current, active, unrestricted Medical License in the U.S.
• Current Board Certification 
• 3+ years of experience in a hospital-based practice setting 
• Demonstrated computer proficiency (i.e., navigating multiple platforms simultaneously, proficient typing skills, MS Office Suite, etc.)
• Demonstrated ability to have meaningful and informed conversations with Case Managers and Attending Physicians
• Must be willing/able to adhere to the schedule expectations of the role and flexible to work evenings/weekends/holidays as business needs dictate and require 
• Must be willing/able to work at least 3 holidays per calendar year

Preferred Qualifications: 

• Active, unrestricted MD or DO License in CA 

Soft Skills:

• Solid organization and communication skills 
• Problem solving 
• Team player mentality 
• Solid clinical knowledge base 
• Superior documentation skills
• Work Independently 
• Self-motivated 
• Dedicated remote workspace free from distractions following the company required telecommute compliance rules and regulations 
• Work the designated schedule required per business needs

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from ∙ For face-to-face roles use established pay transparency range $160,000 - $300,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.