Hennepin County Medical Center seeks a Lead Physician Advisor to evaluate hospitalized patient needs with resources to meet quality, clinical, and regulatory standards. The Lead Physician Advisor assists with performing Utilization Management level of care chart reviews and provides clinical perspective on case management questions. Additionally, this provider will oversee protocols, standard work and schedules for the Physician Advisor program. In collaboration with the Medical Director of Clinical Documentation Improvement, will perform chart reviews for Hospital Acquired Conditions and Patient Safety Indicators and collaborate on other tasks related to improving inpatient provider documentation as appropriate.
Full or part time opportunity. Part time role as Leader Physician Advisor will be .60 FTE. Full time role would encompass .50 Physician Advisor role and .50 clinical appointment in specialty area.
•Conduct level of care reviews not meeting criteria by nurse reviews; review with providers when a level of care change is suggested •Evaluate complex care and discharge issues, continued stay medical necessity and delay in service delivery concerns •Provide advice and education regarding provider utilization questions •Readmission review for assessment of claim modification •Payer denial and audit review for medical necessity and necessary appeals •Preclaim reviews for high audit medical necessity risk areas •Chart reviews for Hospital Acquired Conditions, Patient Safety Indicators, and provider documentation deficiencies •Observation list review and assessment for transfer to inpatient level of care •Assess Medical Surgical outliers for certification of medical necessity •Assist with development of Physician Advisor schedules, meetings, protocols for reviews, standard work •Education to providers and hospital staff in collaboration with the Medical Director of Case Management, Manager of Case Management •Work with Medical Director of Case Management, Director of Transition Care assisting with Utilization Management Advisory Committee agendas, goals •Interdepartmental work with Regulatory Review and Analysis, Revenue Cycle Management, Health Information Management (Coding, CDI), and Revenue Integrity in collaboration with the Medical Director of Case Management •Be available for development of payer contracts, internal policy development related to medical necessity •Implementation of new processes related to updated regulations, leadership requests, and medical staff needs
•MD or DO with clinical experience and current Minnesota medical licensure •Minimum of two years’ experience in utilization management •Experience in using an electronic health record, and clinical leadership, and clinical systems workflow •Excellent communication skills (verbal and written) as well as data analysis and process evaluation skills •Strong broad based clinical knowledge
Internal Number: 161272
About Hennepin County Medical Center
Hennepin Healthcare System, Inc. operates Hennepin County Medical Center in downtown Minneapolis and primary care clinics in suburban Minneapolis communities.
Hennepin County Medical Center is:
•Minnesota's premier Level 1 Adult Trauma Center and Level 1 Pediatric Trauma Center with many nationally recognized programs and specialties
•A recognized system of primary care clinics and retail clinics located throughout Hennepin County
•An essential teaching hospital for doctors who go on to practice throughout the state
•A safety net hospital providing care for low-income, the uninsured and vulnerable populations, and
•A major employer and economic engine in Hennepin County.
We partner with our community, our patients and their families to ensure access to outstanding care for everyone, while improving health and wellness through teaching, patient and community education, and research.
•Patient & Family Centered