Physician Advisor

Physician Pivot; Chattanooga (TN); Vor Ort; USD 110.000 - 170.000; Vollzeit

Zusammenfassung

Physician Pivot in Chattanooga, TN seeks a Physician Advisor to participate in peer-to-peer discussions with Medicaid/Medicare and commercial payers. You will provide expert guidance on admission status and medical necessity, supported by clinical evidence and CMS regulations.

You will collaborate with IT to ensure compliant processes, promote UM staff development, and contribute to denials reduction and revenue improvement.

Qualifikationen

• Minimum of 5 years of clinical practice in the physician specialty or prior work as a Physician Advisor.
• MD or DO degree with residency completion; de-escalation training if applicable.
• Tennessee medical licensure and board certification in practice specialty.
• Willing to obtain CHCQM-Board Certified in Health Care Quality Management and CHCQM-PHYADV subspecialty Board Certification as a Physician Advisor in HCQM.

Aufgaben

• Participate in peer-to-peer discussions with managed Medicaid, managed Medicare and commercial insurance medical directors.
• Provide subject matter expert guidance regarding utilization management activities that involve admission status, medical necessity, CC44, OC72, the two midnight rule, etc.
• Work with IT to ensure logical processes, best practices, and compliance with CMS regulations.
• Promote professional development of the UM staff with a focus on compliant patient status assignments and documentation of primary screening criteria.
• Assist with training of all new UM department hires and drive improvement initiatives.

Kenntnisse

Utilization management

Clinical decision making

Ausbildung

MD or DO degree

Residency completion

Fellowship program

Jobbeschreibung

Job Summary

Participate in peer-to-peer discussions with managed Medicaid, managed Medicare and commercial insurance medical directors.

Provide subject matter expert guidance regarding utilization management activities that involve admission status, medical necessity, CC44, OC72, the two midnight rule, etc. This guidance will be supported by clinical evidence and will be compliant with applicable governmental rules and regulations.

Work with IT to ensure logical processes, best practices, and compliance with CMS regulations.

Promote professional development of the UM staff with a focus on compliant patient status assignments, consistent use and documentation of primary screening criteria (MCG and Indicia), knowledge of the most recent IPO procedure list, IPPS and OPPS annual changes and how they impact status determination, charges, reimbursement, and interrater reliability of the Physician Advisors.

Work collaboratively with Revenue Integrity to reduce denial and appeal burdens and increase revenue by improving the accuracy of initial patient status determinations.

Interface with Compliance as a subject matter expert for government regulations and annual audits.

Assist with the development and driving of improvement initiatives including providing feedback to medical staff regarding utilization management determinations.

Pursue Positions As a Member Of Strategic Committees Outside The Organization That Will Assist The Authority To Be Aware Of Current Trends, Compliance With Regulatory Guidance, And Influence Of State� And National Policy, Including

• ACPA (American College of Physician Advisors)
• MCG (Physician Advisors Council)
• ABQAURP (American Board of Quality Assurance and Utilization Review Physicians)
• Serve as member of the URC (Utilization Review Committee).
• Serve as member of the Outlier and Recertification meeting.
• Provide secondary level physician reviews and continuing stay reviews.
• When available, participate in IDR (interdisciplinary rounds) to advise on the improvement of clinical resource utilization and throughput.

Assist with training of all new UM department hires.

Perform such other duties as reasonably requested by Erlanger or otherwise necessary to properly assist in the operations of assigned areas.

Minimum Requirements

A minimum of 5 years of clinical practice in field of specialty or previous work as a Physician Advisor.

Education

M.D. or D.O. degree. Completion of an approved residency and, if applicable, fellowship program.

De-escalation training if applicable.

Licensure

Licensed to practice in the State of Tennessee.

Certification

Board Certification in practice specialty.

Willing to obtain CHCQM-Board Certified in Health Care Quality Management

Willing to obtain CHCQM-PHYADV- subspecialty Board Certification as a Physician Advisor in HCQM

Erlanger Baroness Hospital Chattanooga, TNPhysician Advisor - Full-time

Standard Hours

Regular