Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Physician Advisor Onsite - New Orleans, LA

Although the Physician Advisor (PA) is employed by Optum, the intention is that the PA will become a key member of the client hospital's team charged with meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. To this end, the PA will develop expertise on matters regarding medical necessity, documentation best practices and concurrent denial payor peer to peer interactions. Physician Advisor will be required to work onsite at the facility M-F during standard facility business hours.
The Physician Advisor will work closely with medical staff, including house staff and actively engage with hospital leadership and utilization management teams related to both medical necessity status reviews and concurrent denial reviews.

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

** All Physician Advisors have a Shared, Minimum Holiday coverage requirement which is covered remotely.

Primary Responsibilities:

• Conduct second level medical necessity/compliance status reviews for all payor types
• Requirement to gain and sustain a working knowledge of the technical systems to perform case reviews
• Meet with case management, utilization management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status through case reviews
• Interacting with medical staff to discuss medical necessity and concurrent denial cases
• Act as a consultant for the medical staff regarding their decisions for the appropriate medical necessity status of hospitalized patients and supporting documentation
• Participate in the claims denial process by conducting peer to peer discussions with commercial payor medical directors for cases that have been denied concurrently
• Coordinate with Optum/OPAS Subject Matter Expert(s) for questions regarding federal, state and payor and regulatory requirements
• Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application
• Provide focused case by case education on utilization management topics (e.g., documentation) to the medical and UM staff
• Develop and maintain a working knowledge and understanding of OPAS proprietary guidance regarding clinical diagnoses and disease states. Initial and ongoing training will be provided by OPAS

Physician Advisor Will Not:

• Practice medicine during the hours scheduled, which includes:
  • Decision-making in a patient's plan of care or discharge
  • Write orders or prescriptions
  • Provide on-call coverage
  • Set hospital clinical or administrative policies
  • Supervise house staff or hospital employees
• Participate in any type of peer review (e.g., Quality, M&M)
• Participate in clinical research or clinical trials
• Participate in the medical decision making of any hospital patient regarding appropriate treatment or course of medical care
• Reproduce or recreate Optum's proprietary guidance for distribution or use in any client
  educational modules
• Execute any contracts on behalf of Optum
• Post opinions related to medical necessity and patient status in any publicly disseminated publication/website without prior approval by appropriate Optum resources

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:

• MD or DO
• Current, unrestricted Medical license in state of residence
• Board certified/eligible
• 3+ years of experience in a hospital-based practice setting
• Demonstrated ability to build rapport with medical staff and hospital leadership
• Ability to collaborate and partner with multiple constituents (administrative, clinical, leadership, etc.)
• Ability to be receptive to feedback and coaching
• Proven solid communication and listening skills
• Demonstrated organizational agility, assumes positive intent, discovers the power pathways and circuits, navigates the organizational maze to get things done
• Proven solid computer skills and working knowledge of EMRs
  

Preferred Qualifications:

• Physician Advisor and or Utilization Review experience

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

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington residents is $248,582 to $3338,965 per year. Salary range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.


Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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