Job SummaryThe Physician Advisor collaborates with Care Managers and Attending Physicians to align on the level of care, patient billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives, and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides the team to improve clinical and financial outcomes with documentation and clinical education.
Core Job Responsibilities- Educate and supports physician documentation for appropriateness of admission and continued stay, severity, and morbidity/mortality.
- Review patient status when admission criteria is non-sufficient for admission.
- Monitor observation and the application of the 2nd Midnight across payor types (CMS regulation).
- Perform concurrent review and escalation of cases not meeting criteria.
- Provide guidance and advisory services
- Deliver support associated with palliative care, end-of-life-care and hospice.
- Track and trend outcome Key Performance Indicators (KPIs) for financial and compliance best practice results. Provide individual education based on trends and regulatory changes.
- Must be onsite
Education/Experience RequirementsREQUIRED: - Active member of a Medical Staff with > 5 years' experience.
- Broad range of medical/clinical knowledge.
- Expertise in, or willing to learn utilization management, state/federal regulations, private payer contracts.
- Dedication to quality, safety, efficiency, satisfaction, cost reduction.
- A good communicator with strong interpersonal skills.
- Willing and able to have "difficult conversations" with physicians.
- Ability to work with front-line staff and executive leadership.
- Propensity for teaching others.
PREFERRED:Licensure/Certification RequirementsREQUIRED: - Active NY State medical license.
PREFERRED: - Certification preferred or eligibility for certification in utilization management via certifying boards within 1-2 years of practice.
Job DetailsReq Id 91471
Department MEDICAL DIRS OFFICE - MVHS
Shift Days
Shift Hours Worked 8.00
FTE 1
Work Schedule PHYSICIAN
Employee Status A1 - Full-Time
Union Non-Union
Pay Range 200,000-300,000
