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 deliver compassionate care every day. As part of our integrated healthcare system, Dignity Health-Yavapai Regional Medical Center (DH-YRMC) is dedicated to providing a wide array of inpatient and outpatient services, fostering an environment for professional growth.

DH-YRMC stands as a non-profit healthcare provider, encompassing two comprehensive acute care hospitals along with outpatient service centers and specialized clinics. Our advanced facilities cater to a diverse range of medical needs, including specialized care for wound management and breast health.

Our extensive service area of 5,500 square miles encompasses various specialties, including cardiac and neurosurgery, as well as a dedicated Women's Health Pavilion. Recognized nationally for our quality of care, DH-YRMC has received multiple accolades, including the Stroke Care Excellence Award and Neuroscience Excellence Awards.

Responsibilities

Role Summary:

Reporting directly to the Chief Medical Officer, the Clinical Advisor is pivotal in advocating for evidence-based medical practices while ensuring optimal utilization of hospital resources. This newly established role focuses on enhancing communication among Care Coordination, Medical Staff, Nursing Staff, and Administration, addressing regulatory and quality aspects of medical service delivery.

Key Responsibilities:

  • Reduce payment denials from insurance providers through effective secondary medical necessity evaluations.
  • Ensure compliance with Centers for Medicare and Medicaid Services (CMS) Conditions of Participation through thorough medical necessity assessments.
  • Promote efficient resource management and stewardship.

Inpatient Facility Responsibilities:

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

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 status determinations and levels of care.

Qualifications

Experience:

  • A minimum of five years in clinical practice.
  • Active membership in good standing within 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 technical skills.
  • Excellent collaboration and communication abilities.

Training:

  • Familiarity with utilization management and quality assessment principles.

Benefits:

  • Comprehensive Medical/Dental/Vision Insurance.
  • Flexible spending accounts and retirement plans.
  • Paid Time Off (PTO) and tuition reimbursement.
  • Support for mental health and wellness.

We are an equal opportunity/affirmative action employer.

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