Physician Advisor
Physician Advisor
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Overview
At Dignity Health living our values means bringing passion into action every day. Dignity Health-Yavapai Regional Medical Center (DH-YRMC) now part of CommonSpirit Health is a not-for-profit integrated healthcare provider that offers a broad range of inpatient and outpatient services including network-wide opportunities to advance your career.
By joining YRMC youll be a part of a dynamic and innovative healthcare organization that is committed to making a positive impact on the community.
Responsibilities
Reporting to our CMO the Physician Advisor plays a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of hospital resources. This newly created positions emphasis is on facilitating communication between the Department of Care Coordination Medical Staff Nursing Staff and Administration regarding systems-based practice regulatory and quality considerations in the delivery of medical care. Performs the duties of this role according to the organizational objectives hospital policies standards of practice and Federal and State regulations.
- Mitigate denials for payment from insurance payers by providing valid and effective secondary medical necessity reviews. Review and report performance measures and make recommendations to Departments and the Medical Executive Committee regarding opportunities for improvement of patient care resource utilization billing compliance and reduction of claims denials.
- Provide compliance element for Centers for Medicare and Medicaid Services (CMS)Conditions of Participation (COP) by performing secondary medical necessity reviews.
- Provide a more cost-effective delivery of secondary medical necessity reviews than what is currently provided by outside contracted services (Executive Health Resources (EHR).
- Champion good stewardship of resources.
- Work with Chiefs of Staff / CMOs to obtain membership on the Medical Staff Medical Executive Committee (MEC) and assist in facilitation on Facility Utilization Management Committee.
Qualifications
Minimum Experience:
- Minimum of five years clinical practice experience.
- Active member in good standing of Hospitals medical staff and participating member of various medical committees.
Minimum Education:
- Doctor of Medicine (MD or DO).
Minimum Licensure:
- Licensed to practice medicine without restrictions in the State where performing Physician Advisor duties: MD:AZ or DO:AZ.
Minimum Special Skills:
- Strong clinical judgment and technical abilities.
- Strong collaboration skills with other physicians.
- Excellent interpersonal and communication skills.
Minimum Training:
- Knowledgeable in basic principles of utilization management and quality assessment.
Required Experience:
Unclear Seniority
Employment Type
Unclear
