Physician Advisor Jefferson Health

Job Details

Job Description

Provides consultation on the level of care utilization of resources discharge issues and options timeliness and appropriateness of care payment denials and other issues. Consults with physicians to improve the efficiency of care delivery transitions of care and clinical documentation.

Essential Functions

• Interacts with co-workers visitors and other staff consistent with the values of Jefferson.
• Reviews clinical information on patients to determine the appropriate status 25%
• Performs Peer to Peer (P2P) reviews to attempt to overturn denials from Payors 40%
• Writes backend appeals to overturn denials from Payor.
• Consults with Case Managers to aid in Discharge Planning.
• Consults with Providers to aid in determining appropriate level of care for patients.
• Expedites discharges to complete work-up out of hospital.
• Participates in periodic trainings as necessary.

Competencies:

• Values differences: Recognizing the value that different perspectives and cultures bring to an organization.
• Customer focus: Building strong customer relationships and delivering customer-centric solutions.
• Manages conflicts: Handling conflict situations effectively with a minimum of noise.
• Instills trust: Gaining the confidence and trust of others through honesty integrity and authenticity.
• Action orientation: Taking on new opportunities and tough challenges with a sense of urgency high energy and enthusiasm.
• Communicates effectively: Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.
• Collaborates: Building partnerships and working collaboratively with others to meet shared objectives.
• Interpersonal savvy: Relating openly and comfortably with diverse groups of people. Ensures accountability: Holding self and others accountable to meet commitments.
• Ensures accountability: Holding self and others accountable to meet commitments.
• Self-development: Actively seeking new ways to grow and be challenged using both formal and informal development channels.
• Optimizes work processes: Knowing the most effective and efficient processes to get things done with a focus on continuous improvement.
• Cultivates innovation: Creating new and better ways for the organization to be successful.
• Tech savvy: Anticipating and adopting innovations in business-building digital and technology applications.
• Demonstrates self-awareness: Using a combination of feedback and reflection to gain productive insight into personal strengths and weaknesses.
• Nimble learning: Actively learning through experimentation when tackling new problems using both successes and failures as learning fodder.
• Being resilient: Rebounding from setbacks and adversity when facing difficult situations.

Education:

• Medical Degree (MD/DO or equivalent)

AND

Experience:

• Five (5) years Delivering direct patient care in a hospital setting

Minimum Certifications Registration or License Requirements:

PA Medical License Upon Hire

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.

Benefits

At Jefferson we offer a comprehensive total rewards package designed to support the health and well-being of our colleagues and their families. It includes a wide range of benefits including competitive pay health and retirement benefits life and disability insurance paid time off educational benefits financial and mental health resources and much more. Our diverse benefits offerings ensure you have the coverage and access to services you need to thrive both personally and professionally.