Clinical Physician Advisor

Cone Health; Greensboro (NC); On-site; USD 180,000 - 220,000; Full time

Job summary

An established industry player in healthcare is on the lookout for a Clinical Physician Advisor to enhance patient care efficiency and regulatory compliance. This role involves reviewing medical records, interacting with medical staff, and providing education on care levels and community resources. The ideal candidate will have extensive clinical experience and a strong background in quality improvement. Join a dynamic team dedicated to delivering top-tier healthcare services in a vibrant community with rich cultural offerings and outdoor activities.

Qualifications

• Minimum 5 years of clinical experience, including 1-3 years in Quality Improvement and Utilization Management.
• Must hold a valid NC medical license and board certification.

Responsibilities

• Review medical records to assist with care level and length of stay determination.
• Provide education on regulatory requirements and utilization of care levels.
• Analyze patterns of service utilization and make recommendations.

Skills

Analytical Skills

Effective Communication

Organizational Skills

Education

MD or DO

Board Certification

NC Medical License

Physician Advisor Certification

Healthcare Administration Education

Job description

Job Description: Clinical Physician Advisor at Cone Health

Cone Health, a not-for-profit health system in Greensboro, North Carolina, is seeking an experienced FM/IM physician to serve as its Clinical Physician Advisor.

Responsibilities:

1. Review medical records of identified patients to assist with the level of care and length of stay determination.
2. Interact with medical staff members and medical directors of third-party payers to discuss patient needs and alternative levels of care.
3. Provide education to physicians and clinicians on regulatory requirements, appropriate utilization of care levels, community resources, and end-of-life care.
4. Develop strategies and processes to reduce denials and audits, assist with appeals, and review resources and service management suggestions.
5. Utilize hospital data sources to identify and analyze patterns of service utilization and quality metrics, making recommendations for improvement.
6. Suggest treatment recommendations for specific cases and discuss these with the healthcare team.
7. Act as a consultant and resource to attending physicians regarding hospitalization appropriateness, continued stay, and resource use.
8. Review cases retroactively for billing appropriateness and appeals.

General Requirements:

• Monday to Friday, 8 am - 5 pm
• Ensure appropriate denials management and resource utilization
• Serve as a resource to medical staff, clinical staff, utilization management, CDI, Transitions of Care teams, case managers, and leadership
• Provide feedback on care levels, length of stay, and quality issues
• Guide on individual and aggregate case levels to optimize patient care efficiency
• Review cases for hospital notice of non-coverage (HINN)/Important Message from Medicare (IM)
• Effective communication skills, analytical, organizational skills

Qualifications:

Educational/Licensure: MD or DO, board certification, NC medical license, unrestricted DEA, Cone Health medical staff membership, Physician Advisor Certification, and healthcare administration/leadership education (e.g., Physician Leadership Academy or equivalent).

Experience: Minimum 5 years of clinical experience, including 1-3 years in Quality Improvement and Utilization Management.

About Cone Health:

A 5-hospital system with over 1100 beds, committed to top-tier performance and physician engagement.

Community and Location:

Greensboro, NC, located in the "Triad of NC," offers excellent schools, cultural events, sports, dining, and outdoor activities, with easy access to travel and natural attractions.

For more information, visit: Greensboro Life, Greensboro Professionals, Greensboro.