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Clinical Advisor

2 months ago

Prescott, Arizona, United States Dignity Health Full time

Position Overview

At Dignity Health, our commitment to excellence drives us to enhance the health and well-being of our community. Dignity Health-Yavapai Regional Medical Center (DH-YRMC), now part of CommonSpirit Health, is a non-profit healthcare organization that provides a comprehensive array of inpatient and outpatient services.

Our extensive healthcare network encompasses two fully equipped acute care hospitals, outpatient service centers, and a variety of primary and specialty care clinics. We are also home to advanced facilities for IV wound and breast care.

With a service area spanning 5,500 square miles, YRMC offers an unmatched continuum of care, including specialized services such as cardiac surgery, neurosurgery, and a dedicated Women's Health Pavilion. Our institution has received numerous accolades for quality care, including national recognition for excellence in service delivery.

Dignity Health-Yavapai Regional Medical Center fosters a strong sense of community, security, and belonging. Our dedication to compassionate care has been recognized with awards such as the Stroke Care Excellence Award and Neuroscience Excellence Awards, placing us among the top providers in healthcare.

As you develop your career at DH-YRMC, you will find an inspiring environment that encourages a balanced lifestyle.

  • A welcoming community that blends historical charm with modern conveniences.
  • Residents enjoy four distinct seasons, complemented by nearly year-round sunshine for outdoor activities.
  • A relaxed lifestyle with short commutes allows you to prioritize both your career and family.

Key Responsibilities

Role Summary:

Reporting to the Chief Medical Officer, the Physician Advisor is instrumental in advocating for evidence-based medical practices while ensuring the efficient use of hospital resources. This newly established role focuses on enhancing communication among the Care Coordination Department, Medical Staff, Nursing Staff, and Administration, addressing regulatory and quality aspects of medical care delivery.

Core Responsibilities:

  • Reduce payment denials from insurance providers by conducting thorough secondary medical necessity reviews. Provide performance measure insights and recommendations for improving patient care, resource utilization, and billing compliance.
  • Ensure compliance with Centers for Medicare and Medicaid Services (CMS) Conditions of Participation through diligent secondary medical necessity reviews.
  • Promote cost-effective secondary medical necessity reviews compared to external contracted services.
  • Advocate for responsible resource stewardship.

Inpatient Facilities:

  • Recognize and respect the unique history and culture of the facility to effectively fulfill job responsibilities.
  • Serve as a resource for teams aligned with facility utilization initiatives, educating medical staff on best practices and regulatory matters.
  • Enhance revenue capture through oversight of appropriate status determinations.
  • Improve cost management by overseeing level of care determinations, consulting with healthcare professionals as necessary.
  • Actively participate in facility utilization management processes to ensure compliance with CMS regulations.

Care Coordination:

  • Provide advisory support to staff facing care transition challenges, advocating for quality patient care.
  • Engage with physician staff on care transitions and resource utilization discussions.
  • Facilitate timely reviews of resource use to optimize patient length of stay and minimize claim denials.
  • Promote best practices in documentation for medical necessity.

Qualifications

Experience:

  • A minimum of five years of clinical practice experience.
  • 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 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.
  • Matching retirement program.
  • Fully funded pension plan.
  • Paid Time Off (PTO).
  • Tuition reimbursement programs.
  • Mental health benefits.
  • Employee life insurance.
  • Annual incentive pay based on organizational performance.
  • Relocation assistance, if applicable.

Pay Range:

$123.07 per hour

We are an equal opportunity/affirmative action employer.