Clinical Advisor

2 weeks ago

Prescott, Arizona, United States Dignity Health Full time

Position Overview

At Dignity Health, our commitment to excellence drives us to provide outstanding healthcare services. As part of our integrated healthcare network, we are dedicated to delivering a comprehensive range of inpatient and outpatient services, ensuring a fulfilling career path for our employees.

About Dignity Health

Dignity Health is a not-for-profit healthcare organization recognized for its exceptional quality of care. Our facilities include full-service acute care hospitals, outpatient service centers, and a variety of primary and specialty care clinics. We pride ourselves on our extensive continuum of care, which encompasses advanced surgical services, a comprehensive Women's Health Pavilion, and specialized programs.

Our organization is deeply rooted in community values, fostering a culture of compassion and quality care. We have received numerous accolades for our dedication to healthcare excellence, making us a leader in the industry.

Key Responsibilities

Role Summary:

Reporting directly to the Chief Medical Officer, the Clinical Advisor is instrumental in advocating for evidence-based medical practices while ensuring the efficient use of hospital resources. This pivotal role focuses on enhancing communication among various departments, including Care Coordination, Medical Staff, Nursing Staff, and Administration, to address regulatory and quality standards in healthcare delivery.

Core Duties

  • Reduce payment denials from insurance providers by conducting thorough secondary medical necessity reviews and reporting performance metrics to relevant departments.
  • Ensure compliance with Centers for Medicare and Medicaid Services (CMS) Conditions of Participation through diligent review processes.
  • Promote resource stewardship and optimize the cost-effectiveness of medical necessity reviews.

Inpatient Facility Responsibilities:

  • Understand the unique history and culture of the facility to effectively fulfill job responsibilities.
  • Serve as a resource for teams focused on utilization initiatives, providing education on best practices and regulatory compliance.
  • Oversee appropriate status determinations to enhance revenue capture and optimize care costs.

Care Coordination Support:

  • Advocate for quality patient care by identifying and addressing barriers to efficient healthcare delivery.
  • Engage with physician staff to discuss care transitions and resource utilization.
  • Conduct medical necessity reviews to support appropriate care levels and status determinations.

Qualifications

Experience:

  • A minimum of five years in clinical practice.
  • Active membership in good standing with the hospital's medical staff.

Education:

  • Doctor of Medicine (MD) or Doctor of Osteopathy (DO).

Licensure:

  • Must hold an unrestricted medical license in the state of practice.

Skills:

  • Strong clinical judgment and collaboration skills.
  • Excellent communication abilities.

Training:

  • Familiarity with utilization management principles and quality assessment.

Benefits

We offer a comprehensive benefits package to support our employees and their families, including:

  • Medical, Dental, and Vision Insurance
  • Flexible Spending Accounts
  • 403(b) Retirement Plan with matching
  • Fully Funded Pension Plan
  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Mental Health Benefits
  • Employee Life Insurance
  • Annual incentive pay based on company performance
  • Relocation assistance when applicable

Compensation

The pay range for this position is $123.07 per hour.

We are an equal opportunity/affirmative action employer.

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