Physician Advisor
1 month ago
- Purpose: Provides physician leadership and expertise related to care coordination, length of stay (LOS)/Ievel of care (LOC) management, care variation management, patient flow/throughput management, ancillary service utilization (e.g., lab and radiology) and clinical documentation improvement (COl)
- Policy-Setting Responsibilities: Responsible for reviewing and providing physician perspective for policies that relate to care coordination, care progression, patient access, care variation management and COl
- Decision-Making Authority: Responsible for collaborating with the care coordination, nursing, patient access, ancillary services and COl departments to meet established goals and for leading physician participation and compliance with responsibilities
- Supervisory Responsibility: Responsible for engaging physicians in care coordination, care progression, patient access, care variation management and COl activities
Applicant Skills/Background
1. Minimum Educational Training Required:
- Graduate of an accredited medical school
- Completion of specialty residency (e.g., Internal Medicine, Emergency Medicine)
2. Experience:
- Five years recent experience in clinical practice in a hospital strongly preferred
- Two years administrative background as physician manager preferred
- Previous experience as a physician advisor preferred
- Experience leading large-scale change efforts preferred
- Experience in academic medicine, if applicable
3. License, Registration or Certification Required :
- Board Certified/Eligible Physician licensed in the applicable states
- Certification by American Board of Quality Assurance
- Utilization Review Physicians (ABQAURP) preferred
4. Knowledge, Skills and Abilities:
- Strong clinical acumen
- Knowledge of case management principles, processes, and their practical application preferred
- Working knowledge of third-party payor guidelines/medical necessity criteria (e.g. , knowledge of admission criteria for all levels of care)
- Experience with denials management
- Knowledge of clinical, quality, and administrative facets of the healthcare industry
- Familiarity with clinical documentation requirements
- Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building this knowledge through experience and partnership with Case Management
- Excellent communication and presentation skills (both written and oral)
- Teaching and coaching skills
- Analytical ability and problem-solving skills
- Working knowledge of electronic medical record
- Knowledge of process improvement methodology
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