Sr Internal Auditor

3 weeks ago

Dayton, United States University of Nebraska Full time

The Physician Advisor (PA) conducts clinical review on all cases referred by the ICM, CDI staff and CSI staff (or other health care professionals) for the purpose of meeting regulatory requirements in accordance with the hospitals objectives for assuring high quality, safe patient care along the care continuum. The PA works in collaboratively with ICM/CSI/care providers to assure effective and efficient utilization of health care services. The PA meets with ICM and CSI staff on a regular basis to discuss select cases, review status determination and make recommendations for follow up. The PA interacts regularly with medical staff and APPs for review of patient care, supporting documentation, discharge plans and appropriate levels of care. The PA acts as a consultant and resource for medical staff, ICM, CSI, CDI and other care providers. The PA provides education to physicians and other clinicians related to regulatory requirements, appropriate utilization, alternative levels of care, community resources, and the overall continuum of care. As needed the PA interacts with medical directors of third party payers to discuss the needs of patients and appropriate levels of care. The PA supports medical staff and APPs through serving as a resource for clinical documentation. The PA attends daily huddles, participates on the utilization management team. The PA collaborates with the hospitalist team on a regular basis for assuring safe, effective and efficient care The PA maintains current knowledge of federal, state and payer regulatory requirements as well as utilization and quality management.

Education Minimum Level of Education Required: Medical Doctorate degree

Additional requirements: Type of degree: MD or DO Area of study or major: Medicine Preferred educational qualifications: N/A Position specific testing requirement: CHCQM Phy Adv certification

Licensure/Certification/Registration Physician licensed to practice in the state of Ohio CHCQM Physician Advisor certification Board Certification in some specialty - current or expired

Experience Minimum Level of Experience Required: No prior job-related work experience Prior job title or occupational experience: Minimum of 5 years of experience in clinical practice Prior specific functional responsibilities: Prior experience in Utilization Management Preferred experience: Prior experience in Utilization Management Other experience requirements: Leadership in practice, programs and projects

Knowledge/Skills Utilization management Payer practices Clinical documentation Patient levels of care Continuum of Care management

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