What are the responsibilities and job description for the Lead Physician Advisor position at Holy Cross Health?
Employment Type
Full time
Shift
Description:
Position Title: Lead Physician Advisor
Employment Type: Exempt
What We Offer
Competitive salary
Benefits – Medical, Dental & Vision, PTO, Free Parking, Metro Access, Tuition Reimbursement, 403(b) and DailyPay Payroll Advance Program
Quality of Life: Flexible work schedules
Advancement: Career growth opportunities
Location: Holy Cross Health has two hospitals and four healthcare centers all a short driving distance from Washington DC and Baltimore, MD
General Summary
Provides physician leadership and expertise related to appropriate utilization/level of care (LOC), length of stay (LOS) management, patient flow/throughput management, appropriate clinical documentation and CDI. Provides oversight for other Physician Advisors. 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.
The employee supports the Mission of Trinity Health and Holy Cross Hospital.
Essential Functions
Provides physician leadership for physician advisors and physicians throughout the organization. Manages processes, policies, workflows and overall management of the physician advisor role within the organization. Works to lead standardization of policy, procedure and approach to physician advisor roles in utilization management, length of stay, denials/downgrades.
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.
Supports care team to ensure appropriate patient placement, care/discharge/etc. Ensures medical staff have understanding and compliance with applicable areas of expertise.
Provides instructional input and education to medical staff and CDI staff. Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation.
Conducts 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 Education/Training Required
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 to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.
00568017
Full time
Shift
Description:
Position Title: Lead Physician Advisor
Employment Type: Exempt
What We Offer
Competitive salary
Benefits – Medical, Dental & Vision, PTO, Free Parking, Metro Access, Tuition Reimbursement, 403(b) and DailyPay Payroll Advance Program
Quality of Life: Flexible work schedules
Advancement: Career growth opportunities
Location: Holy Cross Health has two hospitals and four healthcare centers all a short driving distance from Washington DC and Baltimore, MD
General Summary
Provides physician leadership and expertise related to appropriate utilization/level of care (LOC), length of stay (LOS) management, patient flow/throughput management, appropriate clinical documentation and CDI. Provides oversight for other Physician Advisors. 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.
The employee supports the Mission of Trinity Health and Holy Cross Hospital.
Essential Functions
Provides physician leadership for physician advisors and physicians throughout the organization. Manages processes, policies, workflows and overall management of the physician advisor role within the organization. Works to lead standardization of policy, procedure and approach to physician advisor roles in utilization management, length of stay, denials/downgrades.
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.
Supports care team to ensure appropriate patient placement, care/discharge/etc. Ensures medical staff have understanding and compliance with applicable areas of expertise.
Provides instructional input and education to medical staff and CDI staff. Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation.
Conducts 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 Education/Training Required
- Graduate of an accredited medical school
- Completion of specialty residency (e.g., Internal Medicine, Emergency Medicine)
- Board Certified/Eligible Physician licensed in the applicable states
- 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
- Demonstrated knowledge of clinical, quality, and administrative facets of the healthcare industry.
- 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
- 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
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 to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.
00568017
Salary : $249,426 - $374,140
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