Located conveniently in the heart of Phoenix, Arizona,St. Joseph's Hospital and Medical Center is a 571-bed, not-for-profit hospital that provides a wide range of health, social and support services. Founded in 1895 by the Sisters of Mercy, St. Joseph's was the first hospital in the Phoenix area. More than 125 years later, St. Joseph's remains dedicated to its mission of caring for the poor and underserved.
We are extremely proud to be a nationally recognized center for quality quaternary care, medical education and research. St. Joseph's includes the internationally renowned Barrow Neurological Institute, Norton Thoracic Institute, Cancer Center at St. Joseph's, Ivy Brain Tumor Center, and St. Joseph's Level I Trauma Center (which is verified by the American College of Surgeons). The hospital is also a respected center for high-risk obstetrics, neuro-rehabilitation, orthopedics, and other medical services. St. Joseph’s is considered a sought-after destination hospital for treating the most complex cases from throughout the world. Every day, approximately 20 percent of the hospital’s patients have traveled from outside of Arizona and the United States to seek treatment at St. Joseph’s.
U.S News & World Report routinely ranks St. Joseph's among the top hospitals in the United States for neurology and neurosurgery. In addition, St. Joseph's boasts the Creighton University School of Medicine at St. Joseph's, and a strategic alliance with Phoenix Children's Hospital.
St. Joseph's is consistently named an outstanding place to work and one of Arizona's healthiest employers. Come grow your career with one of Arizona's Most Admired Companies.
For the health of our community ... we are proud to be a tobacco-free campus.
The Physician Advisor plays a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of hospital resources. The position's emphasis is on facilitating communication between the Department of Care Coordination, Medical Staff, Nursing Staff, and Administration regarding systems-based practice, regulatory and quality considerations in the delivery of medical care. Performs the duties of this role according to the organizational objectives, hospital policies, standards of practice and Federal and State regulations.
- 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 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).
- Champion good stewardship of resources.
Inpatient Facility Care Coordination:
- Provide advisory support to staff in their care transition challenges. Advocate for and facilitate quality patient care by identifying systems barriers, practice variances or resource challenges that impede, delay or interfere with efficient, effective and appropriate health care delivery.
- Engage physician staff in discussions concerning transitions of care.
- Engage physician staff in discussions concerning utilization of resources. Facilitate the timely prospective, concurrent, or retrospective review of resource use in referred cases, with the objective of optimizing length of stay and reducing avoidable days and claim denials.
- Influence physician practices to optimize documentation for medical necessity staff.
- Complete medical necessity reviews for status determinations and levels of care as tasked by care coordination staff during standard business days / hours.
- Provide medical necessity documentation for status determination changes as encountered on facility patient care units.
- Minimum of five years clinical practice experience.
- Active member in good standing of Hospital's medical staff and participating member of various medical committees.
- Licensed to practice medicine without restrictions in the State where performing Physician Advisor duties.
- Strong clinical judgment and technical abilities.
- Strong collaboration skills with other physicians.
- Excellent interpersonal and communication skills.
- Knowledgeable in basic principles of utilization management.
- Doctor of Medicine (MD or DO) preferred.
We offer the following benefits to support you and your family:
- Medical/Dental/Vision Insurance (no premium for employee benefits)
- Flexible spending accounts
- Matching 403(b) retirement program
- Fully Funded Pension Plan
- Paid Time Off (PTO)
- Tuition Reimbursement
- Employee Assistance Program (EAP)
- Employee Life Insurance
- Annual Performance Bonus
- Relocation assistance as needed
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