Physician Advisor I
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
This is a remote position and will require you to work Mountain Time Zone or Pacific Time Zone business hours.
As the Utilization Management Physician Advisor (PA), the 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 providing quality patient care, to assure effective and efficient utilization of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level of care, as well as, communicates remotely with medical staff members and medical directors of third party payers to discuss the needs of patients and options/alternatives for care. The PA acts as a consultant to, and resource for, attending physicians regarding their decisions relative to appropriateness of hospitalization, appropriate level of care for initial hospitalization and continued stay days, clinical documentation, 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 must demonstrate interpersonal and communication skills and must be clear, concise and consistent in the message to all constituents.
- Conducts medical record review in appropriate cases for medical necessity of hospital admission, continued hospital stay, adequacy of discharge planning and quality care management.
- Understand the intricacies of 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 staff.
- Understand the intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG.
- Contacts Case and Utilization Management Teams: Makes telephonic/electronic contacts with case and utilization management to discuss clinical aspects of hospital encounters, as well as, medical necessity and appropriate levels of care.
- Contacts Attending Physicians: Makes telephonic/electronic contacts with Attending Physicians to discuss clinical aspects of hospital encounters, as well as, medical necessity and appropriate levels of care. Discussion may also include education for improved clinical documentation, in addition to, governmental and commercial guidelines for reimbursement.
- Conducts Peer to Peer discussions with payers as needed.
- MD or DO
- Minimum of 1 year of experience as a Physician Advisor.
- Minimum of 5 years of clinical practice experience.
- Unrestricted license in field of practice in one or more states.
- Graduate of an accredited medical school
- Broad-based knowledge regarding clinical practice.
- Broad knowledge base with trust and respect of medical staff physicians.
- In-depth knowledge of CMS regulations, including understanding of the 2-midnight rule.
- Utilization management experience.
- Education in quality and utilization management through continuing medical education programs and self-study.
- Knowledge of and practical use of good business English, spelling, arithmetic, practices and the ability to communicate effectively using written and verbal skills.
- Experience performing Peer to Peer Reviews
A compensation range of $157,331 - $204,526 is the reasonable estimate that CommonSpirit in good faith believes it might pay for this particular job based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that include health/dental/vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility and more
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CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.
CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.