Physician Advisor
Company: Legacy Health
Location: Portland
Posted on: October 18, 2024
Job Description:
Physician Advisor
US-OR-
Job ID: 24-39978
Type: Part Time - No Benefits
Homebased EE Oregon
Overview
The Physician Advisor provides medical direction/ guidance to the
Care Management Department in the areas of Utilization Management,
Clinical Documentation Improvement, Charge Capture, transitions of
care are related initiatives. The Physician Advisor functions in a
combined advisory, administrative and educational role and serves
as a critical link between Care Management, the Medical Staff and
the hospital for matters related to physician practice and
behaviors as they affect quality and cost outcomes. QUALIFICATIONS:
Education:Graduate of a four year accredited U.S. Medical School or
the equivalent. Experience:
- Minimum five years' experience managing patients with
multi-system issues and comorbidities.
- Demonstrated knowledge of regulatory and compliance
requirements.Licensure/Certification:
- M.D. or D.O. Unrestricted License to practice Medicine in the
applicable state(s).
- American College of Quality Assurance and Utilization Review
Physicians (ABQAURP CHCQM) Board Certification no later than 1 year
from clinic start date.Knowledge/Skills:
- Excellent verbal and written communication skills.
- Demonstrated competence in utilization management and clinical
documentation improvement.
- Clinical knowledge and skills to act as a resource for Care
Management department staff and as a liaison with physicians.
- Knowledge regarding regulatory and compliance requirements for
documentation and billing. PREFERRED LEADER PROFILE: Demonstrates
the ability to act consistently with our Preferred Employee
Profile, exemplify our core organizational values and exhibit the
leadership competencies outlined in the Preferred Leader Profile.
Physician Leadership:
- Engage physicians in the following processes:
- Clinical Documentation Improvement Program;
- Medical necessity and levels of care;
- InterQual Criteria;
- LOS and avoidable day issues;
- Avoidable readmissions;
- Denials;
- Payer contracts and role of the physician with the payer's
Medical Director;
- Effectively communicate with medical staff, addressing patient
care dilemmas with goal of clarifying ambiguity, successfully
managing change and maximizing patient outcomes;
- Integrate principles of quality improvement and evidence-based
practice to improve overall patient care.Transitions of Care:
- Facilitates communications between the hospital systems that
support plan of care-especially the timely response of
hospitalists, specialists, and other physicians;
- Provides decision support to physicians as requested for the
development of medical plan of care and transition plan for complex
patients with unclear goals of care and for issues related to
utilization management;
- Provides consultation for patients being considered for Legacy
funded discharge plan;
- Participates in patient care conferences and facilitates the
development of patient-centered care plans where
appropriate.Utilization Management:
- General knowledge of medical necessity criteria for inpatient,
observation and ambulatory status;
- Provides secondary review for determination of patient class
when needed;
- Works within established processes when needed to intervene
with payers, supports denial and appeal activities, admit and
transfer decisions, and issuance of hospital-issued notices of
non-coverage;
- Co-chairs the Utilization Management Committee and related
outlier review meetings;
- Co-chairs the Readmission Committee meetings;
- Provides focused reviews on selected cases;
- Uses data to identify trends, root causes and strategies for
improvement.
- Assists and contributes to the development and implementation
of policies and procedures as needed.
- Remains current with all medical record requirements including
dating and timing of orders and progress notes.Clinical
Documentation Improvement:
- Provides feedback and education to other members of the medical
staff on opportunities for documentation improvement.
- Provides education and assistance to Clinical Documentation
Improvement Specialists on questions of documentation completeness
and accuracy.Equal Opportunity Employer/Vets/Disabled. Sorry, no J1
or H-1B visa opportunities. For additional information please
formally apply or contact Erin Pendergraft at EPENDERG@LHS.ORG.
PI90e1c2492a01-37248-35616962
Keywords: Legacy Health, Gresham , Physician Advisor, Healthcare , Portland, Oregon
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