Physician Advisor

Houston Methodist Clear Lake; Silver Spring (MD); On-site; USD 205,000 - 307,000; Full time

Benefits offered by this job

Free parking

Employee discounts

Flexible work schedules

Job summary

Holy Cross Health in Maryland is seeking a Physician Advisor to lead utilization review, LOC/LOS management and CDI initiatives across our hospital system.

You will collaborate with physicians and care teams, ensure regulatory compliance and support denials management. Strong clinical documentation and process-improvement skills are essential. Excellent communication and teaching abilities are expected.

Qualifications

• Graduate of an accredited medical school with MD/DO degree.
• Completion of specialty residency (e.g., Internal Medicine or Emergency Medicine).
• Active Maryland medical license or eligibility.

Responsibilities

• Optimize inpatient/observation care and LOS management with care teams.
• Collaborate to ensure appropriate patient placement and discharge planning.
• Provide CDI education and support for medical staff and CDI personnel.
• Maintain knowledge of UR, LOC regulations and accreditation requirements.
• Perform peer-to-peer reviews to assist with payer determinations and denials.

Skills

Care Management

Denials management

EMR knowledge

Clinical documentation

Education

Medical school graduate

Internal Medicine residency

Emergency Medicine residency

Tools

Electronic Medical Records system

Job description

Benefits, Free parking, employee discounts.

Quality of Life: Flexible work schedules to support a healthy work-life balance.
Advancement: Opportunities for professional growth within the organization.
Location: Holy Cross Health operates two hospitals and four healthcare centers, all within a short driving distance from Washington, DC, and Baltimore, MD.

Position Overview:

The Physician Advisor provides expertise related to appropriate utilization/level of care (LOC), length of stay (LOS) management, patient flow/throughput management, appropriate clinical documentation, and CDI. Engages physicians in care coordination, care progression, care consistency and CDI activities. Reviews and provides physician perspective for policies that related to care coordination, patient access, CDI. Collaborates with appropriate departments, leaders, and committees to meet established goals for physician participation and compliance with expectations.Designs, implements, and directs system wide programs for Infection Control, Supports the Mission of CHE Trinity Health and Holy Cross Health.

ESSENTIAL FUNCTIONS

1. Inpatient/Observation Clinical Optimization: Serves as physician expert and provides support to care team and care coordination staff regarding utilization decisions including screening for appropriateness of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource utilization/management, denial management issues, discharge planning (DP) advise and quality issues. Functions as a consultant and resource to other Physician Advisors and primary (attending) physicians.
2. Collaboration: Supports care team to ensure appropriate patient placement, care/discharge/etc. Ensures medical staff have understanding and compliance with applicable areas of expertise.
3. Clinical Documentation Improvement: Provides instructional input and education to medical staff and CDI staff.
4. Regulatory and Accreditation: Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation.
5. Revenue Excellence: conduct verbal and written Peer to Peer reviews to assist with appeals of denied or downgraded coverage determinations by managed care, commercial payers, and recovery audit contractors.

MINIMUM QUALIFICATIONS

• Graduate of an accredited medical school
• Completion of specialty residency (e.g., Internal Medicine, Emergency Medicine)

Experience:

• Five years recent experience in clinical practice in a hospital strongly preferred
• Previous experience as a physician advisor preferred
• Experience with participation in medical staff committees preferred
• Current active medical staff privileges

License, Registration or Certification Required:

• Board Certified/Eligible Physician licensed in Maryland the applicable states

Knowledge, Skills and Abilities:

• Strong clinical acumen
• Knowledge of Care Management principles, processes, and their practical application
• Working knowledge of third-party payer guidelines/medical necessity criteria (e.g., knowledge of admission criteria for all levels of care)
• Understanding of approaches to denials management
• Knowledge of clinical, quality, and administrative facets of the healthcare industry
• Familiarity with clinical documentation requirements
• Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building this knowledge through experience and partnership with Care Management
• Excellent communication and presentation skills (both written and oral)
• Teaching and coaching skills
• Analytical ability and problem-solving skills
• Working knowledge of electronic medical record
• Knowledge of process improvement methodology
• Demonstrated ability to work effectively within the medical staff structure
• Demonstrated ability to work effectively in an inter-professional team
• Ability to work effectively despite a potentially disruptive environment or peer resistance.
• Willingness and ability to participate in ongoing education recommended by Local management leaders and/or Trinity Health

Rate of Pay: $98.65-$147.98

Pay is based on experience, skills and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates.The pay range may also vary within the stated range based on location.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer. Qualified applicants are considered for employment without regard to Minority/Females/disabled/Veteran (M/F/D/V) status

About us:

Holy Cross Health is a Catholic, not-for-profit health system that serves more than 240,000 individuals each year from Maryland's two largest counties — Montgomery and Prince George's counties. Holy Cross Health earns numerous national awards, clinical designations and accreditations across a wide range of specialties for providing innovative, high-quality health care services.

We were named one of America’s 100 Best Hospitals for 2021

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.