Medical Advisor Jobs

Dir, Medical Physician Advisor

From $23,000/yr

Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. Job Description Summary: Supports Utilization Management (UM) and Care Management (CM) by serving as a liaison between these teams, medical staff, and payors. They educate and advise UM, CM, Managed Care, Revenue Cycle, and medical staff while helping improve clinical documentation, patient safety, and quality outcomes. The role includes clinical review of utilization, claims management, and quality assurance for inpatient, outpatient/observation, and referral services. Also acts as a key clinical and business resource for clinicians, payors, and regulatory agencies to promote high‑quality, cost‑effective patient care.Job Description: * Provides clinical support and validation for Utilization Management (UM) and Care Management (CM). * Educates and serves as a resource to Medical Staff on UM/CM best practices and clinical guidelines. * Builds effective relationships with physicians and UM/CM stakeholders. * Advises UM/CM on approaches to clinical questions and provider interactions. * Serves as liaison between facilities, payors, physicians, and ACO programs. * Guides UM staff on authorizations, concurrent review, denials, and medical necessity criteria. * Performs secondary inpatient review escalations and evaluates utilization patterns. * Supports formulation of clinical arguments for level‑of‑care determinations. * Coordinates concurrent and retrospective denial management and assists with appeals. * Develops and maintains relationships with payor Medical Directors to improve claims outcomes. * Conducts peer‑to‑peer discussions with payors to resolve cases and improve collaboration. * Reviews denials data, trends, and KPIs to identify utilization and process improvement opportunities. * Collaborates regularly with CM, CDI, Quality, and Patient Safety teams to improve outcomes. * Participates in Medical Staff committees and provides input on clinical pathways, guidelines, and policies. * Performs other duties as assigned. Knowledge, Skills, and Abilities: * Strong organization skills with attention to detail [Required] * Excellent analytical and problem-solving skills [Required] * Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff [Required] * Understanding of Microsoft Office Products and other appropriate software platforms [Required] * Ability to work in a matrix-management environment to achieve organizational goals [Required] * Ability to translate ethical and legal requirements into practical and sustainable policies, balancing the needs of the business and the interest of patients and member physicians alike [Required] * Demonstrated ability to provide expert medical advice [Required] * Successful history as a practicing physician [Required] * Demonstrated ability to build and sustain relationships in the medical community and a corporate environment [Required] * Payor experience in operations [Required] * Experience in a physician group model [Required] * Knowledge of change management principles, methodologies, and tools [Preferred] * Direct involvement with supporting the development of a Utilization Management and Care Management departments [Preferred] * Prior experience with third party payors [Preferred] Education: * Doctorate [Required] * Master's [Preferred] Field of Study: * Graduate of accredited Medical School [Required] * Master's in Business or Healthcare Administration [Preferred] Work Experience: * 5+ years of experience in hospital medicine in acute care setting [Required] * 2+ years or greater experience as a Physician Advisor [Preferred] Additional Information: * N/A Licenses and Certifications: * Medical Doctor (MD) [Required] * Healthcare Quality and Management Certification (HQCM) [Preferred] Physical Requirements:(Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/23km2677 All the benefits and perks you need for you and your family: * Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance * Paid Time Off from Day One * 403-B Retirement Plan * 4 Weeks 100% Paid Parental Leave * Career Development * Whole Person Well-being Resources * Mental Health Resources and Support * Pet Benefits Schedule: Full timeShift: Day (United States of America)Address: 900 HOPE WAYCity: ALTAMONTE SPRINGSState: FloridaPostal Code: 32714This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Dir, Medical Physician Advisor

From $23,000/yr

Our Promise To You Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. Job Description Summary Supports Utilization Management (UM) and Care Management (CM) by serving as a liaison between these teams, medical staff, and payors. They educate and advise UM, CM, Managed Care, Revenue Cycle, and medical staff while helping improve clinical documentation, patient safety, and quality outcomes. The role includes clinical review of utilization, claims management, and quality assurance for inpatient, outpatient/observation, and referral services. Also acts as a key clinical and business resource for clinicians, payors, and regulatory agencies to promote high‑quality, cost‑effective patient care. Job Description * Provides clinical support and validation for Utilization Management (UM) and Care Management (CM). * Educates and serves as a resource to Medical Staff on UM/CM best practices and clinical guidelines. * Builds effective relationships with physicians and UM/CM stakeholders. * Advises UM/CM on approaches to clinical questions and provider interactions. * Serves as liaison between facilities, payors, physicians, and ACO programs. * Guides UM staff on authorizations, concurrent review, denials, and medical necessity criteria. * Performs secondary inpatient review escalations and evaluates utilization patterns. * Supports formulation of clinical arguments for level‑of‑care determinations. * Coordinates concurrent and retrospective denial management and assists with appeals. * Develops and maintains relationships with payor Medical Directors to improve claims outcomes. * Conducts peer‑to‑peer discussions with payors to resolve cases and improve collaboration. * Reviews denials data, trends, and KPIs to identify utilization and process improvement opportunities. * Collaborates regularly with CM, CDI, Quality, and Patient Safety teams to improve outcomes. * Participates in Medical Staff committees and provides input on clinical pathways, guidelines, and policies. * Performs other duties as assigned. Knowledge, Skills, And Abilities * Strong organization skills with attention to detail [Required] * Excellent analytical and problem-solving skills [Required] * Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff [Required] * Understanding of Microsoft Office Products and other appropriate software platforms [Required] * Ability to work in a matrix-management environment to achieve organizational goals [Required] * Ability to translate ethical and legal requirements into practical and sustainable policies, balancing the needs of the business and the interest of patients and member physicians alike [Required] * Demonstrated ability to provide expert medical advice [Required] * Successful history as a practicing physician [Required] * Demonstrated ability to build and sustain relationships in the medical community and a corporate environment [Required] * Payor experience in operations [Required] * Experience in a physician group model [Required] * Knowledge of change management principles, methodologies, and tools [Preferred] * Direct involvement with supporting the development of a Utilization Management and Care Management departments [Preferred] * Prior experience with third party payors [Preferred] Education * Doctorate [Required] * Master's [Preferred] Field Of Study * Graduate of accredited Medical School [Required] * Master's in Business or Healthcare Administration [Preferred] Work Experience * 5+ years of experience in hospital medicine in acute care setting [Required] * 2+ years or greater experience as a Physician Advisor [Preferred] Additional Information * N/A Licenses And Certifications * Medical Doctor (MD) [Required] * Healthcare Quality and Management Certification (HQCM) [Preferred] Physical Requirements: (Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/23km2677 All the benefits and perks you need for you and your family: * Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance * Paid Time Off from Day One * 403-B Retirement Plan * 4 Weeks 100% Paid Parental Leave * Career Development * Whole Person Well-being Resources * Mental Health Resources and Support * Pet Benefits Schedule Full time Shift Day (United States of America) Address 900 HOPE WAY City ALTAMONTE SPRINGS State Florida Postal Code 32714 This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Medical Advisor

Company Description Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa – products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes. Job Description Medical Advisors are responsible for ensuring that the Scheme Administrator and Managed Healthcare Organisation adheres to clinical and safety standards. Medical Advisors are expected to engage with the Scheme Administrator, Managed Healthcare Organisation and treating healthcare professionals to ensure the highest quality of evidence based medical care is delivered to patients. They are expected to carry out their duties with patience and confidence. Responsibilities Ensuring that patients receive the highest standard of medical care. Encourage a high standard of performance from clinical staff. Ensuring that all healthcare regulations and safety standards are met. Keeping staff updated on new healthcare regulations. Ensuring appropriate risk management without compromising quality of care. Liaising between administration and medical staff. Participate in decision making on the Clinical Review Committee. Assist with the review, update, and feedback of clinical queries and escalations. Participate and review CMS circular for clinical input. Participate in annual CMS Accreditation submissions. Annual review of all clinical protocols to ensure they are updated. Annual review of all formularies. Responsible for liaising with treating providers for admission updates, treatment plans, discharge or referral. Analyse healthcare spend and make recommendations for enhancements and or changes. Reporting to the Health Executive. Key Outcomes Ensure delivery of appropriate cost efficient care without compromising quality of care. Ensure that, as a Managed Care Organisation, Prime Cure complies with all regulations by the respective governing bodies including Council for Medical Schemes. Provide clinical input into the appropriate care of patients. Support Clinical Staff Supervise the clinical team including non-clinical staff to ensure that proper procedures are being followed and that evidence based medicine is being put into practice. Develop and Maintain Clinical Policies, Procedures and Protocols Develop and maintain Clinical Protocols and SOPs. Regular review of medication formularies. Regular review of Maternity program Regular review of HIV program. Review Patient Complaints Review patient complaints and concerns raised through all channels in the business. Review patient surveys, and adjust policies as necessary. Qualifications REQUIRED Medical Degree Valid registration with the relevant professional body – HPCSA. Good Organisational Skills Excellent Written and Verbal communication skills Exceptional interpersonal skills PMB or Medical Scheme Administration PREFERRED Master of Health Administration (MHA) Master of Business Administration (MBA) WORK EXPERIENCE: 4+ years Clinical Experience Physicians with a strong understanding of medical procedures, equipment, and terminology. Additional Information REQUIRED Decision Making Skills Organisational Skills Communication Skills Negotiation Skills Strategic Planning Skills Ability to work well within a team Ability to work under stress and tight deadlines PREFERRED Knowledge of the Healthcare Industry

Senior Medical Advisor (m/w/d)

From $150/yr

Senior Medical Advisor (m/w/d) Neu-Isenburg, Neu-Isenburg Teilweise Homeoffice Vollzeit Flexible Arbeitszeiten Die GBG Forschungs GmbH ist eine der führenden Organisationen für klinische Forschung in der Onkologie – mit Schwerpunkt auf Brustkrebs. Mit rund 150 Mitarbeitenden gestalten wir Forschung, die international Maßstäbe setzt. Wir arbeiten agil, interdisziplinär und mit echter Begeisterung für wissenschaftlichen Fortschritt, der das Leben von Patientinnen verbessert. Die Rolle: Als Senior Medical Advisor (m/w/d) stellen Sie sicher, dass unsere Studien medizinisch fundiert, patientenzentriert und wissenschaftlich exzellent sind. Sie sind medizinische Ansprechperson für interne Teams, Prüfzentren und Sponsoren – und wirken aktiv am Design, der Durchführung und der medizinischen Bewertung klinischer Studien mit. Die Mission: Ihre Mission ist es, medizinisch-wissenschaftliche Exzellenz in jede Phase der klinischen Forschung einzubringen. Sie entwickeln und unterstützen das Design neu