ChristianaCare is searching for an exceptional Physician Advisor to join our team. This is an exciting opportunity to collaborate with a team of esteemed physician advisors and work towards improving appeal overturn rates and the overall appeal process. As a Physician Advisor, you will play a vital role in the Utilization Management and Quality team. Your primary responsibilities will be to collaborate with appeals nurses and administrative staff ensuring the timely delivery of appeals and creating appeals letters specifically tailored to denials to maximize appeal overturn rates. Additionally, you will work closely with payors and our contracting team to enhance the appeal process. This position will have an onsite presence in Newark, DE, with the possibility to occasionally work remotely on select days as permitted by team schedule.

About ChristianaCare:

ChristianaCare is one of the country's most dynamic health systems, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. ChristianaCare includes an extensive network of outpatient services, home health care, medical aid units, three hospitals (1,300 beds), a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women's health. We rank 21st in the nation for hospital admissions and 6th for admission of stroke patients.

Why ChristianaCare:

• ChristianaCare is the largest, non-governmental employer in the state of Delaware offering the best of a large community health care system with teaching and research opportunities.

• President and CEO, Dr. Janice Nevin recognized in the top 50 Most Influential Clinical Executives, 2020 and 2021 and in the top 25 Women Leaders, 2019.

• ChristianaCare is a not-for-profit health care system with 2020 annual revenue of $3.51 million (Dun & Bradstreet) that is continuing to add new clinical programs and expand into new geographic areas.

• Due to our location, you may live in DE, NJ, PA or MD within 1-3 hours from Philadelphia, New York City and Washington, DC as well as the beautiful beach resorts in DE, NJ and MD.

• The region is rich with diverse cultures and offers some of the nation's best public and private schools, colleges and universities.

Key Responsibilities:

• Collaborates with appeals nurses and administrative staff to ensure efficient and timely delivery of appeals.

• Formulate and construct persuasive appeals letters customized to address specific denials, aiming to improve the appeal overturn rates.

• Collaborates with Health Information Management Systems Staff to review cases for clinical documentation and coding opportunities

• Supports the Finance Department with resolving contract and payor issues as appropriate.

• Rounds on assigned nursing units as needed.

• Identifies quality of care and patient safety concerns and works to facilitate resolution to patient care issues.

Position Qualifications:

• Medical Doctorate Degree: MD or DO required.

• At least three years clinical work experience post residency.

• Physician Advisor Certification required within one year of employment.

• Strong understanding of health insurance appeals and denial process

• Excellent communication and writing skills with the ability to construct compelling appeal letters.

• Collaborative approach with the ability to work effectively with cross-functional teams.

Benefits of living in the Delaware Valley:

Working for ChristianaCare offers the best of urban and suburban living with multiple housing options, excellent restaurants and entertainment venues, quality public and private schools and a short driving distance to popular Delaware and New Jersey beaches. The location provides easy access to Washington, DC, Philadelphia and New York City - all within a short drive or train ride from Newark, DE.

ChristianaCare is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.

When we lead with love, excellence is inevitable.

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