Job Title: Care Progression Physician Advisor
Company Overview:
Pulivarthi Group is a premier global provider of staffing and IT technology solutions, renowned for delivering exceptional services tailored to each client's unique needs. With a steadfast commitment to excellence, we merge expertise with innovation, ensuring cost-effective solutions of the highest quality. Our diverse client base spans healthcare, finance, government, and beyond, reflecting our adaptability and proficiency across industries. Operating in the United States and Canada, we pride ourselves on aligning with clients' cultures, deploying top-tier talent, and utilizing cutting-edge technologies. Pulivarthi Group stands as a beacon of reliability, efficiency, and innovation in the realm of staffing solutions.
Job Overview/Summary:
The Care Progression Physician Advisor provides clinical expertise and leadership to support appropriate utilization of healthcare services, level-of-care determinations, and care coordination. This role collaborates with physicians, case management, utilization review teams, and payers to promote quality patient care, regulatory compliance, and optimal reimbursement outcomes while enhancing the overall patient experience.
Responsibilities:
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Provide physician leadership and guidance in utilization review and care progression activities.
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Review medical necessity, level of care (inpatient vs. observation), and compliance with regulatory standards.
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Collaborate with case management and clinical teams to ensure appropriate discharge planning and post-acute placement.
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Engage in peer-to-peer discussions with payers to support medical necessity determinations.
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Promote adherence to evidence-based guidelines and best practices.
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Assist with denial prevention and appeals processes.
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Provide education to physicians and clinical staff regarding documentation improvement, DRG assignment, and reimbursement considerations.
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Support coordination of post-acute care services including Home Health, Hospice, AIM, Palliative Care, SNF, LTAC, Sub-acute, Acute Rehab, and other care settings.
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Promote collaboration among patients, families, caregivers, physicians, nurses, and ancillary staff.
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Demonstrate service excellence and commitment to quality outcomes in all interactions.
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Maintain organized workflows and manage priorities effectively in a high-volume environment.
Primary Skills:
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Utilization Review and Care Progression
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Level-of-care determination (Inpatient vs Observation)
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Peer-to-peer payer communication
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Clinical documentation improvement
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Healthcare reimbursement knowledge
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Case management collaboration
Secondary Skills (Good to Have):
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Knowledge of HMO, PPO, PPS reimbursement models
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Familiarity with CMS Grouper and DRG assignment processes
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Post-acute care coordination expertise
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Managed care environment experience
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Intermediate computer proficiency
Qualifications:
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Doctorate: Graduate of an accredited medical school
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MD (Doctor of Medicine) or DO (Doctor of Osteopathy)
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Unrestricted medical license in state of residence
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Minimum of 3 years of recent relevant clinical experience
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Strong interpersonal, negotiation, and communication skills
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Ability to work independently and exercise sound clinical judgment
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Demonstrated commitment to service excellence and quality patient care
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Excellent time management and organizational skills
Benefits/Perks:
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Competitive compensation
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Leadership role impacting patient care quality and outcomes
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Collaborative interdisciplinary environment
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Professional development opportunities
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Stable schedule with administrative focus
Equal Opportunity Statement:
Pulivarthi Group is proud to be an equal opportunity employer. We are committed to building a diverse and inclusive culture and celebrate authenticity. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, disability, protected veteran status, or any other legally protected characteristics.
