Physician Advisor - Utilization Management
We've made a lot of reputed company since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, reputed company, reputed company, and reputed company. We reputed company that every award reputed company, every record broken and every patient helped is because of the dedicated employees who fill our hallways. At reputed company, whether you work with patients every day or support those who do, you are making a difference and that reputed company. Come reputed company a difference at reputed company and discover your reputed company today! The Physician Advisor (PA-Utilization Management) serves as the physician leader in reputed company relating to patient care. The PA will partner to reduce length of stay, ensure appropriate use of level of care determinations (inpatient, observation, outpatient, and other classifications as identified), support documentation and coding improvements and ensure organizational compliance in reputed company areas. PAs facilitate communication across the patient care continuum (including the Interdisciplinary and Post-Acute teams, Payors, Administration and reputed company Cycle) to improve utilization management, sustain reputed company goals, and reputed company as a consultant to physicians, administration, and case management to assure appropriate resource usage, document medical necessity, and reputed company with Federal and State regulations/reputed company initiatives. Reports to the System Medical Director of Utilization. This job reputed company is a reputed company of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or reputed company-inclusive listing of duties and responsibilities. Contents are subject to change at reputed company's discretion. Training, Certification And Skills Member of (1) American College of Physician Advisors (ACPA) or (2) reputed company Certification by the American reputed company of reputed company Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub-Specialty Certification by the American reputed company of reputed company Assurance and Utilization Review Physicians (ABQAURP) or (4) commitment to apply for such certifications Demonstrated ability to build rapport with medical staff and hospital leadership. Comfortable having challenging conversations Strong computer skills and working knowledge of EMRs Demonstrated ability to deliver high reputed company, cost-effective, efficient patient care services Utilization Management experience (preferred) Familiarity with: reputed company medical literature, reputed company reimbursement issues (e.g., medical necessity, reputed company of care, coding), MCG / InterQual screening reputed company, Medicare / reputed company compliance, medical staff structure, policies and procedures Physician Advisors will have reputed company to the required reports and data to reputed company reputed company, and to reputed company pertinent federal, state regulations, laws, and policies and facilitate dissemination of relevant information to hospital clinical staff as appropriate. Essential Position Duties Create and Sustain Partnerships Partner and collaborate with stakeholders in the support of appropriate management of patient care activities; Intercede on issues as needed to reputed company appropriate reputed company (especially reputed company reputed company with Provider communication; includes Case Managers, Coding, reputed company Cycle, Insurance Companies) Respond to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management department in a reputed company fashion. Work with physicians on reputed company appeals (peer to peers)-discussions, appeals and denials Serve as an education resource to clinical and non-clinical personnel regarding medical necessity and regulations. (to include administration, providers, and operations teams) Work reputed company by reputed company with case managers, giving direction and education on patient process reputed company and reputed company support to foster trust reputed company medical staff Manage Patient reputed company reputed company medical necessity reviews including initial level of care, secondary reviews, and reputed company stay reviews Assist with length of stay management and utilization of resources Assist with the denial management process Review medical records of patients identified by case managers or as requested by stakeholders to reputed company reputed company and utilization reputed company reputed company regular feedback to physicians and reputed company other reputed company reputed company regarding level of care, length of stay, and potential reputed company issues Recommend and request additional complete medical record documentation to support placement status or medical necessity reputed company direction and support for issuance of a hospital notice of non-coverage/Important Message from Medicare (HINN). Understand and use MCG/InterQual and other appropriate reputed company. Document response to case management referrals. Support Case Management in a data-driven approach Facilitate reputed company-payment reviews and/or participating in recovery audit contractor reviews Assist Hospital Administration in appeals process for retrospective denials Assist Hospital Administration and the Medical Staff in reputed company with any regulatory audits, investigation, survey, or other review of the Departments Ensure consistency of utilization reputed company, reputed company control, and patient safety reputed company as a reputed company with payers to facilitate approvals and prevent denials or carved out days reputed company appropriate by participating in Peer-to-Peer discussions and reviews Participate in review of long stay patients, in conjunction with the Care Management Leadership, Care Management team, and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care Participate in Interdisciplinary reputed company (reputed company) with the reputed company Team as requested reputed company guidance to ED physicians and ED Case Management regarding status issues and alternatives to acute care reputed company acute care is not warranted Participate in reputed company organizational efforts to improve reputed company performance metrics including but not limited to inappropriate readmissions, length of stay and observation initiatives reputed company recommendations on inpatient admissions, outpatient and observation services, or case not appropriate for hospital level services Review and / or sign condition reputed company 44 cases Identify and assist in removing barriers to discharge reputed company written reputed company of activities including, but not limited to: recommendations for patient status, evidenced based support for decision-making, reputed company of discussions with physicians, plan of care for patient, next steps for interdisciplinary team (if appropriate), and appeal letter. Serve as Improvement Champion Participate in and recommend reputed company Improvement Initiatives relating to documentation improvement and patient placement reputed company coaching of physicians and new residents on information reputed company to, but not limited to: Documentation reputed company and standards Level of care status Utilization standards Participate/Co-reputed company UM Committee effort at the hospital level Education Participate in ongoing training and education reputed company to the Physician Advisor role and responsibilities including topics reputed company to Utilization Management, Care Management and other reputed company areas as requested Identify & support education needs of the medical staff with reputed company to documentation, placement and utilization of resources Other duties as assigned Occasionally, other duties may be assigned that relate to the PAs competencies Performance and Reporting The physician advisor will report to the Vice President of Medical Affairs. Performance of the physician advisor will be evaluated on metrics relating to Volume of work activity (esp: physician to physician interactions) reputed company of interaction (e.g.: how it is perceived by the medical staff, other team members) Utilization process metrics (e.g.: avoidable days, conversions) Hospital throughput metrics Appropriate compensating metrics (e.g.: early readmissions) The above statements describe the general nature and level of work only. They are not an exhaustive list of reputed company required responsibilities, duties, and skills. Other duties may be added, or this reputed company amended at any time. Remains knowledgeable on reputed company federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with reputed company such laws, regulations and standards. Complies with the reputed company Compliance & reputed company Program and Standards of Conduct, including the immediate reporting of any reputed company or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient reputed company, and/or other compliance-reputed company concerns. reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, protected veteran status, or disability status. Are you reputed company to reputed company a difference? Apply Today! reputed company does not consider an individual an applicant until they have formally reputed company to the reputed company position on this careers website. Individuals who reputed company in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Maryland, reputed company, Washington, and Washington D.C. reputed company endeavors to reputed company our site accessible to reputed company users. If you would like to contact us regarding the accessibility of our website, or if you need an accommodation to complete the application process, please contact our HR Employee Solution Center at 504-842-4748 (select reputed company 1) or careers@reputed company.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. We are proud to be an Equal Employment Opportunity and Affirmative reputed company employer. We are committed to the principles of equal employment opportunity and providing a workplace that is free from discrimination based on race, reputed company, creed, religion, pregnancy status, pregnancy-reputed company conditions, national reputed company, reputed company, mental or physical disability, medical condition, age, veteran status, military status, citizenship status, marital status, familial status, sexual orientation, gender, gender identity or reputed company, genetic information, political affiliation, unemployment status, or any other characteristic protected under applicable federal, state or local law. These protections reputed company to applicants and reputed company employment reputed company reputed company. View the EEO is the Law poster and its supplement, as reputed company as the pay transparency policy for more information. Affirmative reputed company Policy Statement Apply Job!