Physician Advisor

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 relate 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

• 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 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
• Previous experience with participation in medical staff committees preferred
• Current active medical staff privileges
• Licenses, Registrations or Certifications: 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, 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.

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.