Physician Advisor-6027

Job description

Position Title: Physician Advisor Position Code: PhyAdv-6027 Department: Case Management Oracle Title: Physician Advisor-6027 Reports to: Director Safety Sensitive: ☒ Yes ☐ No Exempt Status: ☒ Yes ☐ No Position Purpose: All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country. Key Responsibilities: - Perform timely and compliant medical necessity reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements and directly communicating any necessary - Facilitate denials management through review of selected cases, conducting peer to peer discussion with third party payers as appropriate, and assisting with appeals letters - Work closely with hospital leadership, medical staff, and hospital ICM leaders to support system CPIs and initiatives - Partner with hospital leadership, physician advisors, and corporate administration to standardize best practices in utilization management and care progression. - Conducts medical record review in cases in question for medical necessity of admission, need for continued...