Physician Advisor, Care Progression, Alta Bates Summit Medical Center

Job Description

The Physician Advisor (PA) is a key member of the hospital's leadership team. The PA develops expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial management, and compliance with governmental regulations and commercial insurance contracts.

Responsibilities

• Develops relationships with System Enterprise and the hospital to optimize the use of Sutter Health Internal Physician Advisor Services (IPAS).
• Works closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to develop and implement methods and strategies to optimize the use of hospital services.
• Conducts clinical reviews on cases referred by UM/CM staff and/or other healthcare professionals to meet regulatory requirements in accordance with the hospital objectives for assuring quality patient care and effective, efficient utilization of health care services.
• Meets with care management, UM staff, and health care team members and medical directors of third-party payers to discuss the needs of patients and alternative levels of care.
• Acts as a consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.
• Acts as a resource for the medical staff regarding federal and state utilization and quality regulations.

Requirements

• Education: Doctorate from an accredited medical school; MD or DO degree.
• Certification & Licensure: Unrestricted medical license in state of residence.
• Typical Experience: 3 years of recent relevant experience.
• Skills & Knowledge: Excellent interpersonal communication and negotiation skills; broad knowledge base of health care delivery and case management within a managed care environment; comprehensive knowledge of Utilization Review, levels of care, and observation status; some awareness of healthcare reimbursement systems; proficiency in coding and DRG assignment process; ability to communicate effectively with various stakeholders; intermediate computer skills; ability to promote teamwork and interact effectively with key internal and external constituents; excellent verbal and written communication skills; excellent time management skills; commitment to service excellence in all patient, family, and employee interactions and job responsibilities.

Qualifications

• Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses, and other ancillary partners.
• Must be able to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
• Must demonstrate commitment to service excellence in all patient, family, and employee interactions and in performing all job responsibilities.

Benefits

Yes

Pay

$136,073.60 to $217,724.00 / annual salary