PHYSICIAN ADVISOR
Position: Physician Advisor
Dept: Physician Advisors
Shift: Full Time 8am - 5pm / 40 hours per week with option to maintain support clinical skills
Premier Health, a private nonprofit academic health system in Southwest Ohio, offers award-winning medical care across multiple acute care hospitals, outpatient facilities, physician practices, and long-term care facilities. We are dedicated to enhancing the lives of our community members through our coordinated approach to health care delivery. Our mission is to care, teach, innovate, and serve, driven by our core values of integrity and ethics. In partnership with Wright State University and the Boonshoft School of Medicine, we excel in medical education, clinical research, and community health. Join us and be part of a team committed to inspiring better health.
The Physician Advisor provides leadership for efficiently managing resource and utilization to deliver quality cost-effective care in the most appropriate setting. Works closely with the medical staff leadership, the entire medical staff, including resident physician house staff in all areas of resource/utilization management to develop and implement methods to optimize use of hospital services for all patients. This includes working with hospital leadership in developing care management protocols with physicians and others to optimize efficient management of resources, insuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, performing Peer to Peer reviews, Short Stay Reviews, Extended Observation. Provides for medical staff education and training as required. Provides periodic reports to Board, MEC and Joint Conference as deemed necessary.
Job Functions
- Status determinations for hospitalized patients
- Perform peer to peers with payors’ medical directors
- Review observation patients daily
- Attend daily MDRs with active LOS-Throughput management
- Collaborates with the CDI/Coding team on Query Escalation and Documentation Improvement opportunities
- Build relationship with medical staff and leadership to get their buy-in with UM, CDI & Coding issues
- Attend UM Committees as subject matter expert
- Assist with denials and appeals as appropriate
- 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)