Lead Physician Advisor

About This Role

This role involves leading the efficient management of hospital resources and utilization to ensure quality, cost-effective patient care. The Lead Physician Advisor will develop and implement strategies to optimize hospital services usage and ensure compliance with regulations within revenue cycle management.

Responsibilities

• Provide leadership for efficiently managing resource and utilization to deliver quality cost-effective care
• Develop and implement methods to optimize use of hospital services for all patients
• Work with hospital leadership in developing care management protocols with physicians to optimize efficient management of resources
• Ensure patients are in the appropriate level of care, supporting documentation, coding improvements and compliance
• Perform Peer to Peer reviews, Short Stay Reviews, and Extended Observation reviews
• Provide medical staff education and training as required, and periodic reports to Board, MEC and Joint Conference
• Maintain accountability for achieving utilization / resource management outcomes and support medical staff in clinical progression of patient care
• Review issues identified by UR staff for appropriate follow-up and recommend improvement initiatives
• Respond to requests for assistance on clinical reviews for medical necessity or any other reason in a timely fashion
• Provide consultation to nurses and case management staff regarding complex clinical issues and advise on justification for continued stay and medical necessity
• Develop and disseminate required protocols, policy and procedures to support revenue cycle goals and compliance with regulations
• Participate in ongoing training and education related to the Physician Advisor role and responsibilities, including Utilization Management and Care Management
• Obtain familiarity and working knowledge of standard published criteria such as MCG/InterQual and apply professional judgment
• Facilitate local system utilization management training and education to Boards, MEC and medical staff departments
• Provide for coordination and improvement in QIO audits
• Develop statistical reports related to revenue improvement and denial reduction within scope
• Work with Human Resources on orientation, compliance, scheduling, training, client engagement, quality and dashboards
• Collaborate with other departments, attend company meetings and coordinate updates on new processes, policies and procedures
• Deliver bi-monthly and yearly evaluations
• Lead weekly, quarterly meetings and develop webinar presentations
• Grow Physician Advisory program through speaking at conferences, webcasts and podcasts
• Collaborate with payors to establish strategies to work together

Skills

* Required skills

Benefits