Physician Advisor – Pittsburgh, PA

Duties

• Works 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 for those patients, continued stay in the hospital, and ancillary services ordered.
• When appropriate, discusses the case with the attending physician regarding medical necessity.
• Discusses the case with the insurance company medical director to obtain payer authorization or conducts a peer-to-peer discussion in cases of a denial.
• Provides medical expertise, advice, and support to the Case Management Department.
• Provides education to the medical staff regarding medical necessity and appropriateness of health care services.
• Provides ongoing education to residents/colleagues regarding observation status and case management.
• Assists with appeal letters and participates in data collection activities for utilization management.
• Receives daily report from Nursing Service (Bed Management) and Case Management on all observation cases.
• Reviews the status of observation cases, facilitates use of institutional processes, and communicates with attending physicians and case managers regarding the patient's status.
• Conducts interdisciplinary rounds to drive quality and reduce length of stay in concert with case management, physicians, and the rest of the multidisciplinary team.
• Interacts regularly with coding and clinical documentation specialists.

Qualifications

• Minimum 5 years of clinical practice experience in a hospital setting required.
• Doctor of Medicine (MD) or Doctor of Osteopathy (DO) and Board Certified in any Medical Subspecialty.
• Licensed in the state of Pennsylvania prior to employment.
• PREFERRED: Board Certified in Quality/Physician Advising, Physician Advisor experience in a clinical setting, Physician Advisor experience with cross-functional teams, Physician Advisor experience with large health system, Physician Advisor experience with integrated payer/provider network.

Benefits

The Physician Advisor is an integral part of the Utilization Management Committee and participates in hospital and enterprise-level quality and throughput initiatives.

Pay

Commensurate with experience.

Schedule

Full-time.

Contact Information

Email your CV and direct inquiries to Carissa Johnston | Physician Recruiter carissa.johnston@ahn.org | 412-527-5941