Physician Advisor

Ensemble Health Partners•Cincinnati, OH

15h•Remote

About The Position

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.

Requirements

MD/DO Physician (MUST have)

Nice To Haves

Leadership Decision Making - Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable. Drives results.
Coaching & Building Talent - Achieves results through other leaders by empowering them and providing feedback, instruction and development (coaching the coach) to develop their own associates; plans and supports the growth of individual skills and abilities in preparation for their next role (building bench); focuses on retention of high performers.
Delegation - Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement.
Leading Teams - Inspires and sustains team unity and engagement by developing, motivating, and guiding the team to achieve results together through productive relationships and work.
Executive Communication - Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others’ attention (appropriate, impactful and clear).
Program/Project Management - Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste and exceptional results.

Responsibilities

Status determinations for hospitalized patients
Perform peer to peers with payors’ medical directors
Short inpatient stay reviews
Review observation patients daily
Build relationship with medical staff and leadership to get their buy-in with UM issues
Attend UM Committees as subject matter expert
Assist with denials and appeals as appropriate
Educate medical staff on UM topics
Partner with UR nurses, IA staff, and Case Management to maintain and improve upon the UM process
Track denial trends to assist the team evolve to meet new payor challenges