Physician Advisor

CommonSpirit Health•Burien, WA

5d•Onsite

About The Position

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 138 hospital-based locations, in addition to its home-based services and virtual care offerings. Our Mission As CommonSpirit Health, we make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. To learn more about a calling that defines and unites, please click here for more information about our mission, vision, and values. We are seeking a physician with leadership experience interested in our new Physician Advisor position. This position will work with our St. Anne Hospital in Burien, St. Elizabeth Hospital in Enumclaw, and St. Francis Hospital in Federal Way, WA. 1. The Physician Advisor serves the Hospital through collaborating with, advising, and teaching the Care Coordination Department; serving as a member of the medical staff; and coordinating with Hospital leadership on matters regarding progression of patient care, medical necessity, compliance with regulatory guidelines, payer relationships; clinical documentation integrity, and identification of trends in the over and under-utilization of resources. 2. The Physician Advisor should be a key member of the medical staff and take on the role as leader of the Hospital's utilization review/management committee, which is charged with adhering to regulatory requirements while ensuring high levels of healthcare quality and acceptable levels for the cost of care. 3. The Physician Advisor will conduct clinical reviews on cases referred by case/utilization management and/or other healthcare professionals in accordance with Hospital objectives related to quality care of patients, regulatory compliance, and utilization management (including LOS). 4. The Physician Advisor should discuss his/her role with the Hospital CMO, or similar position, to clearly define expectations and mentorship opportunities. Specifically, the Physician Advisor will be expected to work in close partnership with CommonSpirit Health's Internal Physician Advisor Services (IPAS) to ensure continuity of services provided. 5. Additionally, the Physician Advisor will be expected to understand and appreciate the unique elements of a Hospital's culture, history, and place in the community it serves. All work should be aligned with CommonSpirit Health's Mission, Vision, and Values. 6. Because of the importance of the role of the Physician Advisor and the visibility this role brings, it is expected that the Physician Advisor has a minimum of 5-7 years of leadership experience (or equivalent experience) in inpatient and/or advisory settings and possess the appropriate credentials in good standing. Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area. Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person - body, mind, and spirit - in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth. Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care. We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.

Requirements

Washington license to practice medicine, full and unrestricted.
Board Certified (American Board of Medical Specialties)
Minimum of 5-7 years of leadership experience (or equivalent experience) in inpatient and/or advisory settings and possess the appropriate credentials in good standing.

Nice To Haves

Demonstrate experience with multiple EMR/EHR; beneficial

Responsibilities

The Physician Advisor serves the Hospital through collaborating with, advising, and teaching the Care Coordination Department; serving as a member of the medical staff; and coordinating with Hospital leadership on matters regarding progression of patient care, medical necessity, compliance with regulatory guidelines, payer relationships; clinical documentation integrity, and identification of trends in the over and under-utilization of resources.
The Physician Advisor should be a key member of the medical staff and take on the role as leader of the Hospital's utilization review/management committee, which is charged with adhering to regulatory requirements while ensuring high levels of healthcare quality and acceptable levels for the cost of care.
The Physician Advisor will conduct clinical reviews on cases referred by case/utilization management and/or other healthcare professionals in accordance with Hospital objectives related to quality care of patients, regulatory compliance, and utilization management (including LOS).
The Physician Advisor should discuss his/her role with the Hospital CMO, or similar position, to clearly define expectations and mentorship opportunities. Specifically, the Physician Advisor will be expected to work in close partnership with CommonSpirit Health's Internal Physician Advisor Services (IPAS) to ensure continuity of services provided.
Additionally, the Physician Advisor will be expected to understand and appreciate the unique elements of a Hospital's culture, history, and place in the community it serves. All work should be aligned with CommonSpirit Health's Mission, Vision, and Values.
Lead in clinical process design/improvement sessions
Collaborate with stakeholders in the development of a compliant and efficient Care Delivery Model (CDM) VMMC
Provide clinical expertise related to medical necessity claims
Collaborate on the development and implementation of standard Clinical Care Pathways for defined diagnoses and DRGs
Review issues identified by Care Coordination to ensure appropriate follow-up, recommends improvement initiatives as needed and makes suggestions to providers and appropriate department chairs as necessary
Provide consultation to Care Coordination staff regarding complex clinical issues and advises on next steps
Documents patient care reviews, decisions, and other pertinent information per Hospital/Utilization Management policy
Establish and champion successful relationships with Care Coordination (Utilization Management, Denials Management, and Progression/Transition of Care)
Establish partnership and communication channel with attending physicians
Create strategies to enhance Hospital and post-acute interdisciplinary efforts for maximizing patient/family outcomes
Collaborate with medical staff in the development and measurement of performance standards involving patient care and utilization of resources to achieve optimal outcomes
Notify the case manager of any conflict of interest in reviewing a particular patient record
Collaborate with Care Coordination as needed for Hospital cases that may need issuance of a Hospital notice of non-coverage.
Take ownership of onsite Condition Code 44 process
Assist with Readmission reduction - focusing on 30 days, all causes
Assist with the segmentation of concurrent review offerings into Medicare / Medicaid / Commercial Payors, as needed
Reviews medical records of patients identified by case managers/utilization review nurses, or as requested by other members of the healthcare team, in order to:
Assist with patient status determinations and length of stay management (LOS)
Assist with the identification and management of denials
Make suggestions related to resource utilization and service management
Determine if standards of quality care, as defined by the Hospital's Medical Executive Committee (MEC), are satisfied
Provide feedback to attending and consulting physicians regarding patient status, length of stay, and quality issues
Seek additional clinical information from the attending and consulting physicians as required to make effective patient status determinations, and in doing so, recommends and requests additional, or more complete, medical record documentation to support such determinations
Actively participate in the Hospital's claim denial process, including, but not limited to responding to denials from payers on a concurrent basis; authoring denial letters as needed on retrospective denials; and determining to what extent denied cases will be appealed
Focus on concurrent medical necessity denials
Participate in audits by CMS, RAC entities, or other agents as required
Participate in the utilization review/management committee, in defining operational strategic objectives for the Utilization Management Program and serves as the liaison to other medical staff committees that interface with the utilization review/management committee
Assists with the evaluation of the Hospital's Utilization Management Program
Assist with appropriate utilization of palliative care
Participate in review of long-stay patients, in conjunction with the Director/Manager of Case Management and to facilitate determination of the most appropriate patient status at any given time.
Round daily on the patient care units, and throughout the Hospital, to identify opportunities to impact resource utilization and manage length of stay (e.g., outliers, medical management practices, problematic patient/family dynamics). Typical rounding would be MDRs (multidisciplinary rounds).
Participate in daily engagement huddles
Discuss cases with the attending physician and whether additional clinical information is available or not
Provide education to physicians and other clinicians related to appropriate utilization of alternate levels of care and community resources
Work with physicians to facilitate appropriate discharges across the continuum of care
Facilitate, mentor, educate other physicians regarding payor requirements and CMS guidelines for medical necessity
Conduct physician education sessions to share data, trends, practice patterns, and other relevant information as requested by Hospital leadership
Ensure physician accountability for efficient patient care management
Contact physician to resolve delays and achieve positive outcomes
Communicate to medical staff leaders (e.g., department chairs, medical directors and other attending physicians as necessary) relevant findings of physician's performance when patterns of clinical outcomes demonstrate undesirable variation
Act as consultant and resource to medical staff regarding federal and state utilization and quality regulations
Act as physician liaison between case management/utilization management and providers to communicate the need for end-of-life care with patients and families where appropriate
Liaise with Payer Strategy and Revenue Cycle regarding payer tactics and behaviors, as well as overall patterns and trends for reimbursement
Champion continuous CDI improvements and best practices
Provide support and assistance to Clinical Documentation Specialists and Coders on an ongoing basis by:
Addressing specific documentation issues encountered by CDSs/Coders, including non-compliant physicians
Assisting in determining appropriate questions to ask physician
Facilitating applicable approaches/interventions to use with physicians
Determine the focus of presentations of clinical examples regarding documentation opportunities and specifics based on quarterly trends and presents this information in department meetings
Update Hospital administration and medical staff leadership on changes in physician behaviors related to clinical documentation over time
Review and report on PEPPER metrics; (LOS, CMI, Re-admissions, OBS rates, and governmental audit measures) to Hospital leadership
Support and/or perform the ALJ and DAB appeals process; especially ALJ support
Demonstrate experience with multiple EMR/EHR; beneficial
Patient Experience: Support improvement measures of HCAHPS percentile score for care transition measure - should be attached to facility/commonspirit targets
Patient Experience: Support improvement measures of HCAHPS percentile score for discharge process
Adhere to the standards of employee conduct for CommonSpirit Health