MD-Physician Advisor-Care Coordination - Part-Time

Overview

At Presbyterian, it's not just what we do that matters. It's how we do it. How we do things here makes all the difference.

Presbyterian Medical Group seeks a Board Eligible / Board Certified ACGME or AOA trained Physician to join Presbyterian Hospital in Albuquerque, New Mexico. We're all about well-being, starting with yours. We offer a nationally competitive salary with relocation allowance available, CME allowance and fully paid malpractice insurance.

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Type of Opportunity:
Part Time (.45 to .89) FTE: 0.500000

Summary:

The Physician Advisor is a key member of the healthcare organization's leadership team and is charged with meeting the organization s goals and objectives for assuring the effective, efficient utilization of health care services. The Physician Advisor is a physician serving the hospital through teaching, consulting and advising the Medical Staff, the Utilization Review team, the Case management team and hospital leadership.

The Physician Advisor shall develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements. Primary Score of Service:
The Physician Advisor works closely with Medical Staff leadership, the entire medical staff, case management, social services, discharge planning and utilization management to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided. This includes working with providers, hospital leadership, case management to optimize length of stay, ensuring efficient management of resources and ensuring patients are in the appropriate level of care.

This involves reviewing documentation to support current level of care, monitoring appropriate use of diagnostic and therapeutic modalities and ensuring compliance with government and payer rules for continued hospital care.

Responsibilities:
Organization Expectations:
Participates in required orientation and training related to the Physician Advisor role. Meets production standards within established time requirements. Work product and performance meet quality standards. Maintains confidentiality of patient care and business matters. Participates in ongoing training and education related to the Physician Advisor role, Utilization Management, Care Management and other related areas as requested. Help ensure compliance with regulatory bodies such as CMS and Joint Commission.

Clinical Effectiveness:
Provides consultation to nurses and case management regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management. Responds to request for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management or Utilization Review department in a timely fashion. Maintains accountability for fulfilling the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care.

Works closely with Case Management on complex patient issues/discharge barriers to problem solve and expedite transfer to appropriate level of care. This includes reviewing documentation, supporting current level of care, monitoring the use of diagnostic and therapeutic modalities and ensuring compliance with government and payer rules for continued hospital care.

Essential

Job Duties and Accountabilities:
Excellent customer service and interpersonal skills. Strong analytical skills, written and verbal communication skills with all levels of internal and external customers. Strong organizational skills and ability to set priorities and multi-task, demonstrate flexibility, teamwork and adaptability in the healthcare environment. Ability to effectively present information, both formal and informal. Acute Inpatient/Case Management Functions:
Assist with length of stay management and utilization of resources. Review medical records of patients identified by case managers or social workers or as requested by the health care team in order to perform quality and utilization oversight. Perform medical necessity reviews including initial level of care, secondary reviews and continued stay reviews and document review determinations and actions. Assist with denial management process by performing case reviews, performing Peer to Peer reviews and determining if formal appeal warranted.

Perform Government One day stay (Inpatient) reviews and document determinations. Provide regular feedback to physicians and all other stakeholders regarding level of care, length of stay and potential quality issues. Recommend and request additional and more complete medical record documentation to…