Physician Advisor - Erie, Pa

Allegheny Health Network (AHN) is recruiting a full-time Physician Advisor to join our team located in Erie, PA.

About the role

This job assures the most cost-effective, appropriate use of health care services for patients treated at Allegheny Health Network while correlating patient clinical information with both government and commercial payer utilized regulations and criteria regarding severity of illness, intensity of service, and the appropriateness of the setting for the administration of that care. The Physician Advisor is responsible for level of care reviews and peer-to-peer discussions with payers if denials arise. The role requires significant collaboration with the hospital’s interdisciplinary care team including Physicians, Case Managers, UM nurses, and the hospital leadership team. The Physician Advisor is an integral part of the Utilization Management Committee and participates in hospital and enterprise-level quality and throughput initiatives. This position reports to the Chief Quality Officer and Medical Director of Physician Advisors.

Responsibilities

• Work onsite in concert with the admitting physician, Case Management, and other hospital personnel to evaluate the medical necessity and appropriateness of admission to the hospital, utilization of observation status and services, continued stay in the hospital, and ancillary services ordered.
• Discuss cases with attending physicians regarding medical necessity when appropriate.
• Conduct peer-to-peer discussions with insurance company medical directors to obtain payer authorization or address denials.
• Provide medical expertise, advice, and support to the Case Management Department.
• Educate medical staff regarding medical necessity and appropriateness of health care services.
• Provide ongoing education to residents and colleagues regarding observation status and case management.
• Assist with appeal letters and participate in data collection activities for utilization management.
• Receive daily reports from Nursing Service (Bed Management) and Case Management on all observation cases.
• Review the status of observation cases, facilitate institutional processes, and communicate with attending physicians and case managers regarding patient status.
• Conduct interdisciplinary rounds to drive quality and reduce length of stay in collaboration with case management, physicians, and the multidisciplinary team.
• Interact regularly with coding and clinical documentation specialists.
• Serve as an active member of the Utilization Management Committee.
• Lead and report data on case management and observation services at the monthly Throughput Meeting.
• Review and analyze metric reporting dashboards and implement action plans if goals are not met.

Requirements

• Minimum 5 years of clinical practice experience in a hospital setting.
• Doctor of Medicine (MD) or Doctor of Osteopathy (DO).
• Board Certified in any Medical Subspecialty.
• Licensed in the state of Pennsylvania prior to employment.

Preferred Qualifications

• Board Certified in Quality/Physician Advising.
• Physician Advisor experience in a clinical setting.
• Physician Advisor experience with cross-functional teams.
• Physician Advisor experience with a large health system.
• Physician Advisor experience with an integrated payer/provider network.

Benefits

• Competitive salary and comprehensive medical benefits.
• Sign-on bonus.
• CME allowance.
• EY Financial Planning Services – Student Loan and PSLF Assistance.
• Retirement plans; vested immediately in 401K and 457B.
• Malpractice coverage with tail coverage.
• Loan repayment assistance for qualified candidates.

About the Location

Located directly on one of the Great Lakes, Erie is home to Presque Isle State Park offering 7 miles of beaches, 14 miles of trails, and endless water activities. Enjoy local wineries, breweries, diverse eateries, and ski resorts. The city hosts a variety of educational institutions, including top-ranked school systems. Benefit from the area’s low cost of living and international airport. Erie’s cultural scene and diverse job market make it an ideal place for healthcare professionals to grow.

About Saint Vincent Hospital

Nationally recognized for innovative practices and quality care, Allegheny Health Network is one of the largest healthcare systems serving Western PA. AHN’s Saint Vincent Hospital is a 350-bed tertiary care hospital serving the tristate area. Facilities are equipped with state-of-the-art technology and robotic capabilities. Saint Vincent Hospital has recently opened a brand new 39-bed Emergency Department, an on-site Cancer Institute facility, and four state-of-the-art 700 sq. ft. Operating Rooms. Recently voted Erie’s Choice as the ‘Best Hospital’ and ‘Best Place to Work’, AHN Saint Vincent continues to shine in its commitment to its employees and the Erie community.