Physician Advisor Utilization Management

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Physician Advisor, Utilization Management','Full-time','Hospitalist','Days','Days','80','80','Occasional','Occasional','COLORADO-ENGLEWOOD-DENVER INVERNESS','','!*!Job Summary:
 
As the Utilization Management physician advisor, the Physician Advisor (PA) conducts clinical case reviews referred by case management staff and/or other health care professionals to meet regulatory requirements and in accordance with the hospital’s objectives for assuring quality patient care and effective and efficient utilization of health care services. The PA meets with case management and health care team members to discuss selected cases and make recommendations for care as well as interacting with medical staff members and medical directors of third party payers to discuss the needs of patients and alternative levels of care. The PA acts as a consultant to, and resource for, attending physicians regarding their decisions relative to appropriateness of hospitalization, clinical documentation, continued inpatient stay, and use of healthcare resources. The PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations. The PA will act as a liaison between OneCare (electronic health record capabilities) and the medical staff ensuring that the system is optimized for effective physician use. The PA helps facilitate training for the physicians. The PA must demonstrate interpersonal and communication skills and must be clear, concise and consistent in the message to all constituents.
 
Essential Duties:

This is a work-from-home opportunity, and you must be willing to provide coverage M-F 8am-5pm in either the Mountain or Pacific time zone.

Conducts medical record review in appropriate cases for medical necessity of inpatient admission, need for continued hospital stay, adequacy of discharge planning and quality care management.
Understand the intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, APR-DRG, and the Medicare Inpatient Prospective Payment System (IPPS) to make medical determinations on severity of illness, acuity, risk of mortality, and communicate with treating physicians in cooperation with the utilization team and health information personnel
Serve as a liaison between the national care management team, medical staff, and medical executives to encourage physician cooperation and understanding of documentation importance
Assist in communications of internal physician advisor services in the hospital newsletters and other communication vehicles to further educate the medical staff
Communicate feedback on program results to facility leadership (i.e. CMO, Care Management Directors, Quality Directors)
Provide feedback and education to the Care Management and Clinical Documentation Departments through written and verbal communication as well as appropriate tracking and trending for process improvement efforts.
Attend and participate in facility committee meetings, by invitation, as applicable:

Clinical Documentation Steering Committee
Extended Length of Stay Rounds
Utilization Review Committee
Care Management Staff Meetings
Contacts Attending Physicians:  Makes face-to-face and telephonic/electronic contacts and presentations to all medical staff physicians and potential physician groups introducing referral services, new products and present product offerings.
Conducts Peer to Peer discussions with payers as needed:  Acts as a liaison and coordinator with operations for physicians. Attends applicable committee meetings, such as a Joint Operating Committee (JOC), as requested by Utilization Management or Managed Care: Works with the Care Management Director and staff to facilitate client profiles, clinical service utilization and support for revenue management activities.','!*!Education and Experience:

Graduate of an accredited medical school, preferably board certified in area of practice. 
Minimum of 1 year experience as a Physician Advisor required, with Utilization Management experience as a member of an UM oversight committee.
Broad knowledge base with trust and respect of medical staff physicians.
Additional education in quality and utilization management through continuing medical education programs and self-study.
Minimum of 5 years recent experience in clinical practice.  
Solid understanding of the business and financial considerations of a healthcare organization, including but not limited to, excellent analytical skills, data aggregation, analysis, interpretation, and application
In-depth knowledge of CMS regulations in both the inpatient and outpatient arenas is required
Broad-based knowledge regarding clinical practice, insurance and legal disciplines, hospital operations, and revenue cycle
Knowledge of and practical use of good business English, spelling, arithmetic, practices and the ability to communicate effectively using written and verbal skills.
Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost) for individual users of health care and patient populations','We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.','2017-R0132245','Catholic Health Initiatives - National Office','Physician Advisor, Utilization Management

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