[Hiring] Lead Physician Advisor @Ensemble Health Partners

Role Description

The Lead 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, ensuring 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.

Qualifications

• MD/DO

Requirements

• Maintains accountability for achieving utilization/resource management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care.
• Reviews issues identified by UR staff to ensure appropriate follow-up, recommend improvement initiatives as needed, and make referrals to the appropriate department chair as necessary.
• Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Utilization department in a timely fashion.
• Provides consultation to nurses and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management.
• Provides for development and dissemination of required protocols, policy and procedures to support revenue cycle goals and compliance with regulations.
• Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested.
• Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable.
• Facilitates local system utilization management training and education to Boards, MEC and medical staff departments as required.
• Provides for coordination and improvement in QIO audits.
• Develops statistical reports related to revenue improvement and denial reduction within scope and as requested by Local System Boards, MEC and other local system committees.
• Works with Human Resources on orientation, orientation handbook, compliance, scheduling, training, client engagement, quality and dashboards.
• Collaborates with other departments, attends company meetings and coordinates and provides updates on new processes, policies and procedures.
• Delivers bi-monthly and yearly evaluations.
• Leads weekly, quarterly meetings and develops webinar presentations.
• Grows Physician Advisory program through speaking at conferences, webcasts and podcasts.
• Collaborates with payors to establish strategies to work together.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.
• Professional development investment, including earning a professional certification relevant to their field and tuition reimbursement.
• Quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.