Full-Time Physician Advisor

Position Summary Details

Physician Advisors provide concurrent review and appeal support services for XSOLIS’s XPAS client base, as well as solutions to change the way hospitals solve their administrative challenges. 

This role does not operate solely on "normal business hours" and requires varied shifts from 8:00am to 11:00pm EST with 2 consecutive scheduled days off a week. Additionally, it requires 1 week mandatory training in our TN Headquarters. Our upcoming training is October 27-31. Must be able to attend to be considered. 

Essential Duties & Responsibilities

The essential functions include, but are not limited to the following:

• 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 if professionally recognized standards of quality care are met. 
• Participate in the concurrent and retrospective appeal peer-review process. 
• Provide feedback to internal and external partners regarding level of care, length of stay and quality issues, which may also include joining client meetings to review observations and trends in physician behavior and/or documentation.  
• Recommend and request additional, more complete, medical record documentation.  
• Provide guidance to internal and external staff regarding status issues and alternatives to acute level of care when such care is not warranted.  
• Provide education to internal and external staff related to regulatory requirements, appropriate utilization, and alternative levels of care. 
• Ensure appropriate documentation of patient care reviews, decisions, and other pertinent information.  
• Be able to review cases with screening criteria, such as InterQual, MCG or other appropriate platforms.  
• Develop and apply protocols related to evidence-based medicine and criteria. 
• Work with internal and external Care Management staffs to ensure appropriate continuity of care and provide education to assist in reducing readmissions. 
• Educate internal and external staff about ICD coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology to improve their understanding of severity, acuity, risk of mortality, and DRG assignments on their individual patient records. 
• Provide insight into the development of the XSOLIS appeal operations and technology platform. Work with the Data Analytics team and assist in the enhancement of clinical analytics.  
• Maintain current knowledge of federal, state, and payer regulatory and contract requirements. 
• Additional functions as deemed appropriate and warranted. 
• Complete peer to peer reviews. 
• Perform other duties as assigned. 

Minimum Qualifications (Knowledge, Skills, and Abilities) 

Education:  

• Certification as a Board Certified Doctor of Allopathic (M.D) or Osteopathic (D.O.) Medicine
• Certification of graduation from an accredited medical school: Medical Degree 
• Certification of an active and state-issued Medical License to practice medicine without restriction
• All physicians must maintain an active and unrestricted medical license throughout their tenure with Xsolis

Experience:  

• 5+ years of experience in clinical practice

Other: 

• Knowledge of quality and utilization management and clinical practice. 
• Knowledge of utilization management as an oversight committee member or physician advisor. 
• Knowledge of federal, state, and payer regulatory and contract requirements. 
• Problem solving and conflict resolution. 
• Strong working knowledge of Excel and other Microsoft Office products. 
• Comfortable with routinely shifting demands. 
• Ability to work independently in a fast-paced, dynamic, results-oriented environment.  
• Meticulous attention to detail, self-motivated, with the ability to maintain confidentiality.  
• Excellent communication skills. 

Supervisory Responsibilities
This role does not have any direct reports and is a single contributor role. 

Working Environment and Travel Requirements

• Work is typically in a normal office administrative environment involving minimal exposure to physical risks.
• Position requires little to moderate physical activity. Mostly sedentary work exerting up to 10 pounds of force occasionally or a negligible amount of force to lift, carry, push, pull, or otherwise move objects. Work involves sitting most of the time, but may involve walking or standing for brief periods of time. No significant stooping is usually required.
• Upon hire: 1 week Travel to TN HQ Office for training.
• Flexible schedule with varying shifts between 8:00 AM – 11:00 PM EST; includes two scheduled days off each week.

Physical Demands & Work Environment 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.

Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.