Clinical Resource Advisor

1 week ago

Dayton, Ohio, United States Premier Health Partners Full time

Position:
Physician Advisor

Department:
Physician Advisors

Shift:
Full Time 8am - 5pm / 40 hours per week with option to maintain support clinical skills


Premier Health Partners, a private nonprofit academic health system in Southwest Ohio, is dedicated to providing exceptional medical services across various acute care hospitals, outpatient facilities, physician practices, and long-term care settings.

Our commitment lies in improving the health of our community members through a coordinated approach to healthcare delivery, driven by our core values of integrity and ethics.

In collaboration with Wright State University and the Boonshoft School of Medicine, we excel in medical education, clinical research, and community health initiatives.

The Physician Advisor plays a crucial role in leading the efficient management of resources and utilization to ensure quality, cost-effective care in the most suitable environment.

This role involves close collaboration with medical staff leadership and the entire medical team, including resident physician house staff, to develop and implement strategies that optimize the use of hospital services for all patients.

Key responsibilities include working with hospital leadership to establish care management protocols with physicians and other stakeholders, ensuring patients receive appropriate levels of care, supporting documentation, coding enhancements, compliance, and conducting Peer to Peer reviews, Short Stay Reviews, and Extended Observation.

Additionally, the Physician Advisor is responsible for providing medical staff education and training as needed and delivering periodic reports to the Board, MEC, and Joint Conference as required.

Job Functions

  • Determine status for hospitalized patients
  • Conduct peer reviews with payors' medical directors
  • Review observation patients on a daily basis
  • Participate in daily MDRs focusing on active LOS-Throughput management
  • Collaborate with the CDI/Coding team on Query Escalation and Documentation Improvement opportunities
  • Foster relationships with medical staff and leadership to gain support for UM, CDI & Coding issues
  • Attend UM Committees as a subject matter expert
  • Assist with denials and appeals as necessary
  • Educate medical staff on UM, CDI & Coding topics

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 board certification or ACPA-C Certification
Licensure/Certification/Registration

  • Physician licensed to practice in the state of Ohio
  • CHCQM Physician Advisor certification
  • ACPA-C certification
  • CCDS certification
  • Board Certification in some specialty - current or expired

Experience:

  • Minimum Level of
Experience Required: 2-3 years of experience in UR/Denials/CDI/Coding

  • Prior job title or occupational experience: Minimum of 5 years of experience in clinical practice
  • Prior specific functional responsibilities: Prior experience in Utilization Management, Denials, CDI, Coding
  • Preferred experience: Prior experience in Utilization Management, Denials, CDI, Coding
  • Other experience requirements: Leadership in practice, programs, and projects
Knowledge/Skills:

  • Utilization Management & Utilization Review
  • Payer practices & CMS regulations
  • Clinical Documentation Integrity & Coding
  • Patient levels of care
  • Continuum of Care management
  • Post Acute transition
  • Process Improvement Skills (Lean Six Sigma)

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