Physician Advisor

4 weeks ago

Prescott, Arizona, United States Dignity Health Full time
Position Summary:

As a Physician Advisor at Dignity Health, you will play a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of hospital resources.

This position emphasizes facilitating communication between the Department of Care Coordination, Medical Staff, Nursing Staff, and Administration regarding systems-based practice, regulatory and quality considerations in the delivery of medical care.

You will perform duties according to organizational objectives, hospital policies, standards of practice and Federal and State regulations.

Key Responsibilities:

  • Mitigate denials for payment from insurance payers by providing valid and effective secondary medical necessity reviews.
  • Review and report performance measures and make recommendations to Departments and the Medical Executive Committee regarding opportunities for improvement of patient care, resource utilization, billing compliance and reduction of claims denials.
  • Provide compliance element for Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (COP) by performing secondary medical necessity reviews.
  • Provide a more cost-effective delivery of secondary medical necessity reviews than what is currently provided by outside contracted services.
  • Champion good stewardship of resources.

Requirements:

  • Minimum of five years clinical practice experience.
  • Active member in good standing of Hospital's medical staff and participating member of various medical committees.
  • Doctor of Medicine (MD or DO).
  • Licensed to practice medicine without restrictions in the State where performing Physician Advisor duties.
  • Strong clinical judgment and technical abilities.
  • Strong collaboration skills with other physicians.
  • Excellent interpersonal and communication skills.
  • Knowledgeable in basic principles of utilization management and quality assessment.

Benefits:

  • Medical/Dental/Vision Insurance.
  • Flexible spending accounts.
  • Matching 403(b) retirement program.
  • Fully Funded Pension Plan.
  • Paid Time Off (PTO).
  • Tuition Reimbursement.
  • Mental Health Benefit.
  • Employee Life Insurance.
  • Eligible for annual incentive pay based on company performance.
  • Relocation assistance if applicable.

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