Physician Advisor
About The Position
As our Physician Advisor, you will promote evidence-based medical care and appropriate hospital resource utilization, facilitating communication across medical, nursing, care coordination, and administrative departments. Every day you will advocate for efficient patient care, remove barriers, and collaborate with attending physicians, bolstering the Department of Care Coordination's utilization and compliance efforts. To be successful, you need exceptional clinical acumen, strong communication, and a deep understanding of hospital operations/regulations. Your ability to influence, drive efficiency, and advocate will be paramount for optimizing care and resource allocation. Mitigate denials for payment from insurance payers by providing valid and effective secondary medical necessity reviews. Review and report performance measures and make recommendations to Departments and the Medical Executive Committee regarding opportunities for improvement of patient care, resource utilization, billing compliance and reduction of claims denials. Provide a compliance element for Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (COP) by performing secondary medical necessity reviews. Provide a more cost-effective delivery of secondary medical necessity reviews than what is currently provided by outside contracted services (Executive Health Resources (EHR). Align and collaborate with the facility leadership. Understand and appreciate unique elements of facility history and culture in order to effectively execute/implement job duties and functions.
Requirements
- Five (5) years clinical practice experience
- Doctor of Medicine (MD) or Doctor Osteopathic Medicine (DO) in the state of Arizona.
Nice To Haves
- One (1) year of experience in Utilization Management
Responsibilities
- Promote evidence-based medical care and appropriate hospital resource utilization.
- Facilitate communication across medical, nursing, care coordination, and administrative departments.
- Advocate for efficient patient care and remove barriers.
- Collaborate with attending physicians to bolster utilization and compliance efforts of the Department of Care Coordination.
- Mitigate denials for payment from insurance payers by providing valid and effective secondary medical necessity reviews.
- Review and report performance measures.
- Make recommendations to Departments and the Medical Executive Committee regarding opportunities for improvement of patient care, resource utilization, billing compliance and reduction of claims denials.
- Provide a compliance element for CMS Conditions of Participation (COP) by performing secondary medical necessity reviews.
- Provide a more cost-effective delivery of secondary medical necessity reviews than what is currently provided by outside contracted services.
- Align and collaborate with facility leadership.
- Understand and appreciate unique elements of facility history and culture in order to effectively execute/implement job duties and functions.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
