PHYSICIAN ADVISOR

Core Job Responsibilities

• Educate and supports 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.

Education/Experience Requirements

• REQUIRED:
• Active member of a Medical Staff with > 5 years' experience.
• Broad range of medical/clinical knowledge.
• Expertise in, or willingness to learn utilization management, state/federal regulations, private payer contracts.
• Dedication to quality, safety, efficiency, satisfaction, cost reduction.
• A good communicator with strong interpersonal skills.
• Willing and able to have "difficult conversations" with physicians.
• Ability to work with front-line staff and executive leadership.
• Propensity for teaching others.
• PREFERRED:
• Medical Doctor with MBA

Licensure/Certification Requirements

• REQUIRED:
• Active NY State medical license.
• PREFERRED:
• Certification preferred or eligibility for certification in utilization management via certifying boards within 1-2 years of practice.