Physician Advisor II
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 II, 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.
- 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)
- Provides 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.
- Attends and participates 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.
- MD or DO
- Unrestricted license in field of practice in one or more states.
- Minimum 3 years of experience as a Physician Advisor.
- Minimum 5 years of experience in Clinical Practice.
- Experience performing Peer to Peer Reviews.
- Experience submitting written and verbal appeals.
- 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.
A compensation range of $234,000 - $328,000 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™ 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.