Tenet Healthcare Corporation

Physician Advisor

Tenet Healthcare Corporation • $200K — $250K *
Delray Beach, FL 33445In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • M.D. or D.O. with current state medical license required.
  • ABMS certification required; advanced degree in Business or Health Care Administration preferred.
  • Active hospital medical staff member in good standing required.
  • Preferred experience in Utilization Management and hospital committee leadership.
  • Minimum two years in a physician leadership role with proven clinical excellence.

Responsibilities

  • Lead and support the Utilization Management and Clinical Documentation Improvement initiatives.
  • Maintain communication with medical staff regarding admission and clinical documentation criteria.
  • Assist in managing pre-certification processes for admissions and procedures.
  • Review treatment plans and collaborate with physicians on patient care documentation.
  • Conduct medical necessity reviews and support appeals for denied cases.

Benefits

  • Comprehensive benefits program including relocation assistance.
  • Performance bonus structure to supplement base salary.
Full Job Description
Job Description

Job Shift: Days

Job Type: Full Time

The Physician Advisor (PA) has responsibility for providing medical staff leadership to the Utilization Management Committee (UMC) and functions of the Case Management (CM) and Health Information Management (HIM)/Clinical Documentation Improvement Departments. The PA leads and promotes processes for patients to receive medically necessary and high quality care throughout the continuum of care. The PA also assists in reducing the financial risks associated with denials that are due to providing medically unnecessary or preventable services and extended length of stays.
Additionally, the Physician Advisor provides ongoing education and in-service instruction programs for the Hospital's medical staff (including residents and fellows in academic medical centers), nursing and ancillary personnel related to coding/clinical documentation improvement, compliance, and utilization management and quality issues. Further, the PA conducts and documents reviews and for cost and length of stay (LOS) outliers as referred by the non-physician reviewers. He/she conducts medical necessity reviews for cases not referred to an outsourced physician advisor company.

Responsibilities

POSITION ACCOUNTABILITIES AND PERFORMANCE CRITERIA:
  1. Serves as physician liaison and advisor to the Health Information Management Department/Clinical Documentation Improvement.
    • Shares expertise regarding improvements in documentation with both HIM and clinical staff.
    • Serves as lead educator with the medical staff for ICD-IO and clinical documentation improvement implementation.
  2. Maintains communication with attending physicians relating to utilization management and clinical documentation to discuss criteria for admission and/or continued stay and/or clinical documentation.
  3. Assists Hospital with physician communication in support of the process for Hospital Issued Notice of Non-coverage Letters ("HINN"), Medicare discharge appeals and Condition Code 44 responsibilities of the UM Committee.
  4. Assists Hospital with issues related to appropriate pre-certification for elective admissions, direct admissions and procedures.
  5. Discusses treatment plans with attending/specialty physicians when Case Management and/or Clinical Documentation Improvement staff request assistance related to the patient plan of care or documentation.
  6. Reviews records and reports of patient care in Hospital, as well as cases referred by Hospital's Case Managers, HIM/CDI staff, Risk Managers and Directors of Clinical Quality Improvement to promote quality of patient care and identify utilization issues.
  7. Serves as physician liaison with contracted secondary physician review company responsible for conducting and documenting reviews to determine medical necessity and level of care issues when patients do not meet InterQual@ criteria.
  8. Serves as liaison between Hospital and Managed Care Medical Directors, representing the hospital concerns at regular joint operating meetings between the two organizations.
  9. Supports or serves as chair of the Utilization Management Committee. Shares meaningful data to attendees and committee members. Utilizes data to direct and drive performance improvement. Present UM Plan to required committees and Governing Board.
  10. Utilizes (Crimson) data to drive improved quality of care and reduce unnecessary variation:
    • Active Crimson user/Physician Champion
    • Reviews data regularly (at least monthly)
    • Identifies areas of opportunity and shares with physicians in multiple settings
    • Drives at least one focus improvement through UM Committee Action Plan.
  11. In conjunction with Home Office Health Policy counsel, clarify with appropriate agencies (for example, State Medicaid agencies) regulations that pertain to utilization and denials. Provides feedback, when necessary, to McKesson regarding discrepancies between clinical standards of care and InterQual guidelines.
  12. Supports and assists Case Management, as indicated, in real-time interventions when Hospital is notified of denials/down codes by appealing and reducing denials of payment through peer to peer communication with medical directors from various managed care plans. Communicates, as required, with payers or physicians to facilitate immediate reversal of adverse decisions or transfer to alternative levels of care. Assists with appeals process by sharing case notes, research or related documentation that will support appeal.
  13. Supports and assists Clinical Documentation Improvement staff, as indicated, in real time interventions with concurrent query education needs with the medical staff for clear, concise and compliant documentation in order to support coding/MSDRG and/or APR DRG assignment.
  14. Assists Hospital management in determining and providing the appropriate level of care in Facility and in the Intensive Care and Telemetry Units.
  15. Review cases daily with Case Managers to focus on patients with preventable excess days, social/financial issues and appropriateness of clinical care.
  16. Attends TEMPOTM Board Huddles at least weekly and patient care conferences when indicated.
  17. Assists the appropriate Medical Staff Committee(s) in reviewing and revising Medical Staff Bylaws Rules and Regulations as they relate to utilization management and clinical documentation.

COMPENSATION:

A competitive compensation program will be tailored to the selected candidate. Base salary will be supplemented by a performance bonus and comprehensive, well-rounded benefits program, which includes relocation assistance.

TRAVEL:

Minimal.

Qualifications

EDUCATION/CERTIFICATIONS:

Minimum: A Doctor of Medicine degree (M.D.) or Doctor of Osteopathic Medicine degree (DO.) is required. A current Medical License for the state where practicing as a Physician Advisor. An advanced degree in Business and/or Health Care Administration is desirable. Candidates for this position are required to have an ABMS (American Board of Medical Specialties) certification.

EXPERIENCE:
  • Active hospital medical staff member in good standing with current hospital is required.
  • Utilization Management and hospital committee chair experience highly preferred
  • Demonstrated ability to work in a collegial role with members of the medical staff and to engage in education to hospital medical staff preferred.
  • Solid background in successfully conducting physician-to-physician discussions with payers strongly preferred.
  • Minimum two years of experience in a physician leadership role is required. A demonstrated track record of superior performance in physician leadership roles; a background should have been gained ideally in an health system or major medical group that is recognized for excellence in clinical care and contemporary medical management practices. The successful candidate will be recognized for knowledge in clinical process improvement.
  • Business skills in planning, use of information systems, financial management, budgeting, reimbursement and managed care, healthcare economics, medical practice management, human resources management and team building, program development, community education, and marketing/referral base development.
    Clinical leadership skills in quality and utilization management, clinical effectiveness and outcomes, clinical staff development, case management, clinical protocol development.
  • Demonstrated knowledge of managed care and health policy that encourages visionary thinking.
  • A flexible management style, with the ability to function in an environment where it will be necessary to produce proactive results and to lead major change initiatives in an aggressive time.
  • Significant understanding of and experience with performance improvement and quality management programs.
  • In depth understanding of financial systems and reimbursement mechanisms.
  • Ability to teach and educate and to articulate positions effectively. Excels in effective coaching and counseling of employees, as well as definitive mentoring skills.
  • High-level problem solving capabilities both in groups and one-on-one.


About Tenet Healthcare Corporation

Tenet Fintech Group is an innovative Fintech service provider to the Chinese commercial lending sector.

Tenet Healthcare Corporation Careers

Join the dedicated team at Tenet Healthcare Corporation, a national leader in healthcare services. At Tenet, we are committed to providing the highest quality care and outstanding patient experiences. This commitment extends to our team members in every role across our network.

Work You’ll Do

At Tenet Healthcare Corporation, you will be part of a dynamic team that is passionate about transforming healthcare. Our professionals enjoy a collaborative environment where innovative ideas and a proactive approach to healthcare are at the forefront of what we do.

Explore Job Opportunities and Growth

We offer a variety of job opportunities across clinical, administrative, and corporate disciplines. Whether you are a seasoned professional or just starting your career, Tenet provides a path for growth and development. Our leadership is committed to nurturing talents through advanced training programs, leadership workshops, and continuous professional development.

Innovate and Lead

Join us and contribute to a culture of innovation and continuous improvement. At Tenet, every team member is empowered to make a difference. With access to cutting-edge technology and a network of professionals, you will have the tools to drive real change in healthcare delivery.

Diversity and Inclusion

At Tenet Healthcare Corporation, we celebrate diversity and are committed to creating an inclusive environment for all employees. Our diversity training ensures that our team is respectful, inclusive, and equipped to support the diverse communities we serve.

Internship Programs

Kickstart your career with Tenet’s internship programs. These opportunities allow you to gain hands-on experience while working alongside seasoned professionals. Internships are a great way to develop skills, enhance your resume, and build a network within the healthcare industry.

Benefits and Culture

Our employees enjoy a range of benefits designed to support their physical, financial, and emotional well-being. Join a company that values work-life balance, provides competitive healthcare benefits, and supports your personal and professional growth.

Join Our Team

Are you ready to advance your career in a vibrant healthcare environment? Explore the positions available at Tenet Healthcare Corporation and find where your skills and passion can make a difference. We are actively hiring and looking for individuals who are curious, creative, and eager to drive innovation in healthcare.

Stay Connected

Keep up to date with the latest at Tenet by following our careers blog. Gain insights from our team, learn about our culture, and get tips for your job search and career development.

Networking and Professional Development

At Tenet, networking and professional development are part of our ethos. We encourage our employees to connect, share, and grow together. Enhance your career through comprehensive training, mentorship, and collaboration across our extensive healthcare network.

Apply Now

Discover the rewarding career opportunities at Tenet Healthcare Corporation. Personalize your job search and apply for positions that match your qualifications and interests. Join us in our mission to provide quality care and make a positive impact in the lives of our patients and communities.

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Embark on a fulfilling career journey at Tenet Healthcare Corporation, where your growth is our priority, and your potential is limitless.
Learn more about Tenet Healthcare Corporation
Size
76,836 employees
Market Cap
$5.1 billion
Industry
Healthcare
Net Income
$399 million
Founded
1967
5 Year Trend
-0.1%
Revenue
$17.6 billion
NASDAQ
THC
* Ladders Estimates

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