Corporate Physician Advisor
The Corporate physician advisor (PA) is responsible for managing the efficiency of care delivered at the organization. The Corporate PA works with the medical staff leadership, the attending medical staff, the hospital-based physicians, case/care management/social work, discharge planning, and utilization management to develop and implement methods to optimize use of hospital services for patients while also ensuring the quality of care provided.
To serve as a liaison with providers, case managers, hospital leadership and payors on utilization management and revenue integrity. Provide education to ensure physician documentation appropriately supports the actual care provided.
This includes working with those developing utilization management processes, documentation, working with physicians and others to align length of hospital stay, ensuring patients are in the appropriate level/Status of care, and monitoring the appropriate use of diagnostic and therapeutic modalities.
The PA is responsible for assisting the organization to work with physician practices and hospital leadership in order to achieve the organization’s desired resource management and quality goals.
Responsibilities and Scope of Work
- Provide secondary reviews for appropriate patient status and level of care and discuss with the attending as appropriate.
- Resolve concurrent patient status and level of care disputes with payors and physicians.
- Provide education to physicians and case managers on denial and payor trends, I and medical review criteria, documentation, and CMS/other regulatory requirements and updates.
- Review payor denials and assist in the appeals process as necessary including attending ALJ hearings.
- Review CDI queries for completeness and accuracy, consult with physicians to ensure accurate and timely responses.
- Assist case management in assessing regulatory compliance with Code 44, 72-hour rule, Important Message from Medicare notifications, HINN and two midnight rule.
- Assist case management in reviewing one day stays and provide feedback to physicians.
- Support the hospitals by attending length of stay rounds/meetings, case management meetings and utilization management committee meetings, as available/requested.
Essential Job Duties
- Demonstrates commitment to meeting/exceeding strategic initiatives of organization.
- Maintains accountability for achieving case/care management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care.
- Reviews issues identified by case/care managers to ensure appropriate follow-up, recommend improvement initiatives as needed, and make referrals to the appropriate department chair as necessary.
- Upholds the organization’s values of teamwork, interacting with others with dignity and respect.
- Provides consultation to hospital interradicular team regarding trends in complex clinical issues and advises on next steps.
- Facilitates internal and external relationships with all physician and constituents of case management.
- Creates strategies to enhance hospital and post-acute interdisciplinary efforts for maximizing patient/family outcomes
- Participates in developing and maintaining positive relationships with third-party payers. Ensures processes are followed according to policy and contracts.
- Interacts with the medical staff to achieve optimal outcomes on case specific issues.
- Collaborates with clinical care services and the medical staff
- Demonstrates excellent customer service and interpersonal skills.
- Communicates with the payer’s PA as requested to resolve any disputes surrounding medical necessity approvals for continued stay.
- Participates in Status/ level of care determinations on a case-by-case basis as requested by case managers.
- Collaborates with all department personnel as requested.
- Contributes to appeal process.
- Conducts physician education sessions to share data, trends, practice patterns, and other relevant information as requested.
- Ensures physician accountability for efficient patient care management.
- Participates in coaching and educating physicians on the appropriateness of level of care and timely need for discharge planning.
- Investigates avoidable delays and trends referred by hospital/regional staff that effect patients’ outcomes during their hospital stay.
- Contacts physicians to resolve delays and achieve positive outcomes.
- Demonstrates positive outcomes through interventions with attending or consulting physicians that delay care and affect the length of stay or avoidable delays, etc.
- Identifies denial trends and works with the medical staff and hospital administration to resolve the issues.
- Performs other responsibilities as requested
- Excellent customer service and interpersonal skills.
- Able to effectively present information, both formal and informal.
- Strong analytical skills.
- Strong written and verbal communication skills with all levels of internal and external customers.
- Strong organizational skills, ability to set priorities and multi-task, listening skills, flexibility/openness to change.
- Word processing, general knowledge of office procedures and equipment including copier, computer, and fax machine.
Outcomes and deliverables:
- Provides education sessions for medical staff on trends, practice patterns, or relevant information
Minimum Job Requirements/Competencies
- Maintains a medical license in a Steward Location
- Member of the American College of Physician Advisors Preferred
- Previous utilization management, case management or peer review documentation experience in hospitals or health plans.
- In clinical practice within the past five years.
- Has the ability to travel among the Steward hospitals