Physician Advisor - Utilization Review & Care Management

Mohawk Valley Health System; City of Utica (NY); On-site; USD 180,000 - 230,000; Full time

Job summary

Mohawk Valley Health System (MVHS) is seeking a Physician Advisor to join our team in Utica, New York. The Physician Advisor collaborates with Care Managers and Attending Physicians to align on the level of care, patient billing status, and potential barriers to patient discharge.

The role conducts clinical review to ensure regulatory compliance, hospital objectives, and quality patient care while promoting efficient utilization of resources and providing guidance to improve clinical and

Responsibilities

• Educate and support physician documentation for appropriateness of admission and continued stay, severity, and morbidity/mortality.
• Review patient status when admission criteria is non-sufficient for admission.
• Monitor observation and the application of the 2nd Midnight across payor types (CMS regulation).
• Perform concurrent review and escalation of cases not meeting criteria.
• Provide guidance and advisory services
• Deliver support associated with palliative care, end-of-life-care and hospice.
• Track and trend outcome KPIs for financial and compliance best practice results. Provide individual education based on trends and regulatory changes.

Job description

Mohawk Valley Health System (MVHS) is seeking a Physician Advisor to join our team. The Physician Advisor collaborates with Care Managers and Attending Physicians to align on the level of care, patient billing status, and potential barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives, and quality patient care while ensuring effective and efficient utilization of resources. The Physician Advisor guides the team to improve clinical and financial outcomes with documentation and clinical education.

Position Highlights

• Educate and support physician documentation for appropriateness of admission and continued stay, severity, and morbidity/mortality.
• Review patient status when admission criteria is non-sufficient for admission.
• Monitor observation and the application of the 2nd Midnight across payor types (CMS regulation).
• Perform concurrent review and escalation of cases not meeting criteria.
• Provide guidance and advisory services
• Deliver support associated with palliative care, end-of-life-care and hospice.
• Track and trend outcome Key Performance Indicators (KPIs) for financial and compliance best practice results. Provide individual education based on trends and regulatory changes.

Community Highlights

• Low cost of living
• Excellent real estate
• Rural and urban life within driving distance
• Safe, family-friendly communities
• Access to the Adirondack and Catskill mountain ranges
• Multi-cultural population
• Public and private schools
• Access to Boston, New York City and Canada
• Revitalized downtown
• Newest hospital in New York State

MVHS is dedicated to supporting our physicians and practitioners, enabling them to deliver premier healthcare to our region, keeping our patients as the focus of all we do. MVHS strives to be the trusted healthcare system of choice through clinical quality, excellence in service and education, compassionate care, promotion of wellness and operational efficiency.

The MVHS Medical Group has 16 primary care locations. The group also provides services in many specialty areas including women's and children's health; general, cardiothoracic, vascular, orthopedic and neurological surgery; advanced endoscopy, wound care, bariatric, cardiovascular, comprehensive stroke, cancer, immune health, behavioral health, psychiatry and neurosciences, pulmonary critical care and urology.

MVHS serves Oneida, Herkimer and Madison counties with our flagship, Wynn Hospital, located in Utica, New York. The Utica area boasts one of the largest 15K road races in the nation (Boilermaker), 900 acres of city parks, a zoo, a large arts institute and museums, theaters, a sports/concert arena, numerous historical sites and entertainment options including the Turning Stone Resort Casino and the Utica Comets AHL hockey club. Also known as "the city that loves refugees," Utica is home to more than 40 nationalities and offers extraordinary dining options that include Bosnian, Cambodian, Vietnamese, Italian, German, Caribbean and many more.

Utica is located near the foothills of the Adirondacks, which provides endless opportunities for outdoor activities including hiking, camping, boating, skiing and fishing. Nearby colleges, universities and a technology park provide employment opportunities for spouses and partners. Utica and the surrounding areas have plenty of affordable housing in safe, close-knit communities.