We are seeking an experienced Board-Certified Internal Medicine physician to join our hospital as a Physician Advisor.
Ideal candidate must have 7+ years of experience as an internal medicine/sub-specialty physician. The Physician Advisor (PA) is expected to advise, educate and assist the local facility/facilities through teaching, consulting, and advising the Case Management (CM) Department, Clinical Documentation Improvement (CDI) Department and the medical staff on matters regarding physician practice patterns, documentation, over- and under-utilization of resources, medical necessity, compliance rules and regulations, collaboration and relationships with payers. The PA will work collaboratively with the local leadership to address identified issues with practice patterns of specific providers.
WHAT YOU CAN EXPECT:
- Promote compliance with CMS, State and Payer policy regarding inpatient admissions and observation status, as well as the appropriateness of continued hospital stay.
- Work with Director of Clinical Effectiveness and Care Management to facilitate communication between payers and providers regarding benefit coverage issues, denials, utilization review and quality assurance processes. In addition, position requires professional engagement with the Vice President of Medical Affairs, Corporate Lead PA and System Medical Director of Franciscan Health Olympia Fields
- Ensure Quality improvement activities comply with all relevant requirements by State /Federal/ Accreditation Body.
- Conduct verbal and written review (including peer-to-peer) and appeal of denied or downgraded coverage determinations made by payers at local facility.
- Provide feedback to treating physicians (attending and consultants) on appropriate level of care, length of stay, and quality issues. Also seek additional clinical information from the treating physicians (including appropriate documentation of the plan of care to resolve utilization issues or modification to the treatment plan ) to ensure adherence to regulatory and compliance requirements.
- Reviews medical records of patients referred by the care management team and assist with clinical review for level of care determination, length of stay management, denial management process and determine if MCG criteria or other professionally recognized standards of quality care are met.
- Must portray excellent interpersonal and communication skills, with the ability to build consensus; noticeable skills in engaging physicians and finding synergies.
- The ability to relate well to a wide variety of individuals. Comfortable working in groups, forming teams of physicians and management, with an ease in working with other dive
