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Onsite Physician Advisor

December 1, 2023
Fort Wayne, IN
Job Type
Work Setting


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.

Primary Responsibilities

  • Conduct medical necessity reviews of cases referred by case management to ensure medical necessity and regulatory requirements are met for level of care.
  • Meet with case management, social work, and other healthcare team members to discuss selected cases and make recommendations regarding patient status.
  • Interact with medical staff and medical directors of third-party payers to discuss the needs of patients and alternative levels of care.
  • Act as a consultant for the medical staff regarding their decisions for the appropriate level of care of hospitalized patients and supporting documentation.
  • Participate in the claims denial process, including appeals.
  • Review of utilization data to ensure hospital objectives for quality patient care.
  • Act as a resource for the medical staff regarding federal, state, and payer regulatory, quality, and contract requirements.
  • Serve as a physician member of the Utilization Review Committee, which may require non-clinical medical staff privileges application.
  • Provide education on utilization management topics (e.g., documentation) to the medical and UM staffs.

Required Qualifications

  • MD or DO.
  • Current, unrestricted medical license in state of residence.
  • Solid computer skills and working knowledge of EMRs.
  • Board Certified / Eligible.
  • 3+ years of experience in a hospital-based practice setting.
  • Demonstrated ability to build rapport with medical staff and hospital leadership.

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

Preferred Qualifications

  • Physician Advisor experience.
  • Utilization Management experience.
  • Hospital Leadership or Hospital Committee experience.
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