United States onlyR1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals, and physician practices. Headquartered in Chicago, R1 has employees throughout the US and international locations.
Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients, and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.
The R1 Physician Advisory Services (Treatment Authorization Request) team offers a range of services that help navigate the path to compliant revenue. The Treatment Authorization Review (TAR) team proactively reviews California Medicaid (Medi-Cal) cases concurrently at the time of presentation and post-discharge to ensure proper admission status, which increases compliance and reduces the risk of exposure to denials. This team can also serve as a clinical resource to medical and case management staff by providing identification, facilitation, and resolution of documentation and utilization issues relating to California Medicaid (Medi-Cal) rules and regulations.
Responsibilities:
Addresses the following issues: medical necessity reviews for Medi-Cal payor regulations.
Review and respond to the customer in a timely manner.
Must work during pre-scheduled hours to be highly successful in this role (schedules are created about 30 days in advance).
Physicians should be highly capable of working independently with a high level of performance in in a rapidly changing, fast paced environment.
Successful physicians will need to meet quality and productivity standards.
Actively engage with attending physicians to discuss appropriate status as supported by documentation.
Provide written analysis of the case and perform case reviews across multiple specialties.
Required Skills:
Active, unrestricted MD or DO medical licensure in the state of California.
At least 3 years of experience post-residency completion, focused on treatment of inpatients.
Strong clinical knowledge base across multiple clinical areas.
Computer proficient.
Strong verbal and written communication skills.
Professional, organized and possess persuasive writing and speaking skills.
Possess strong negotiating/reasoning/logic and problem-solving skills.
Must have some flexibility to meet 20 hours a week schedule and cover times of business need.
Must be available for some set weekend hours or to flex to weekend hours as needed for business needs.
Ability to work as part of a team.
Home office that is HIPAA compliant.
Desired Skills:
Current Board Certification or eligibility.
Previous experience with utilization review or chart review.
Previous experience with California Medicaid (Medi-Cal) payer rules
The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.
Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.
R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.
If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.
CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent
To learn more, visit: R1RCM.com
Visit us on Facebook
AU, BR + 8 more