Physician Advisor

Trinity Health•Silver Spring, MD

11d•$99 - $148

About The Position

Position Title: Physician Advisor Type of Position: Exempt What We Offer: Benefits, Free parking, employee discounts. Quality of Life: Flexible work schedules to support a healthy work-life balance. Advancement: Opportunities for professional growth within the organization. Location: Holy Cross Health operates two hospitals and four healthcare centers, all within a short driving distance from Washington, DC, and Baltimore, MD. Position Overview: The Physician Advisor provides expertise related to appropriate utilization/level of care (LOC), length of stay (LOS) management, patient flow/throughput management, appropriate clinical documentation, and CDI. Engages physicians in care coordination, care progression, care consistency and CDI activities. Reviews and provides physician perspective for policies that related to care coordination, patient access, CDI. Collaborates with appropriate departments, leaders, and committees to meet established goals for physician participation and compliance with expectations. Designs, implements, and directs system wide programs for Infection Control, Supports the Mission of CHE Trinity Health and Holy Cross Health. ESSENTIAL FUNCTIONS 1. Inpatient/Observation Clinical Optimization: Serves as physician expert and provides support to care team and care coordination staff regarding utilization decisions including screening for appropriateness of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource utilization/management, denial management issues, discharge planning (DP) advise and quality issues. Functions as a consultant and resource to other Physician Advisors and primary (attending) physicians. 2. Collaboration: Supports care team to ensure appropriate patient placement, care/discharge/etc. Ensures medical staff have understanding and compliance with applicable areas of expertise. 3. Clinical Documentation Improvement: Provides instructional input and education to medical staff and CDI staff. 4. Regulatory and Accreditation: Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. 5. Revenue Excellence: conduct verbal and written Peer to Peer reviews to assist with appeals of denied or downgraded coverage determinations by managed care, commercial payers, and recovery audit contractors.

Requirements

Graduate of an accredited medical school
Completion of specialty residency (e.g., Internal Medicine, Emergency Medicine)
Five years recent experience in clinical practice in a hospital strongly preferred
Previous experience as a physician advisor preferred
Experience with participation in medical staff committees preferred
Current active medical staff privileges License, Registration or Certification Required:
Board Certified/Eligible Physician licensed in Maryland the applicable states
Strong clinical acumen
Knowledge of Care Management principles, processes, and their practical application
Working knowledge of third-party payer guidelines/medical necessity criteria (e.g., knowledge of admission criteria for all levels of care)
Understanding of approaches to denials management
Knowledge of clinical, quality, and administrative facets of the healthcare industry
Familiarity with clinical documentation requirements
Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building this knowledge through experience and partnership with Care Management
Excellent communication and presentation skills (both written and oral)
Teaching and coaching skills
Analytical ability and problem-solving skills
Working knowledge of electronic medical record
Knowledge of process improvement methodology
Demonstrated ability to work effectively within the medical staff structure
Demonstrated ability to work effectively in an inter-professional team
Ability to work effectively despite a potentially disruptive environment or peer resistance.
Willingness and ability to participate in ongoing education recommended by Local management leaders and/or Trinity Health.

Responsibilities

Inpatient/Observation Clinical Optimization: Serves as physician expert and provides support to care team and care coordination staff regarding utilization decisions including screening for appropriateness of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource utilization/management, denial management issues, discharge planning (DP) advise and quality issues. Functions as a consultant and resource to other Physician Advisors and primary (attending) physicians.
Collaboration: Supports care team to ensure appropriate patient placement, care/discharge/etc. Ensures medical staff have understanding and compliance with applicable areas of expertise.
Clinical Documentation Improvement: Provides instructional input and education to medical staff and CDI staff.
Regulatory and Accreditation: Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation.
Revenue Excellence: conduct verbal and written Peer to Peer reviews to assist with appeals of denied or downgraded coverage determinations by managed care, commercial payers, and recovery audit contractors.