Advanced Practice Registered Nurses / Physician Assistants
The Physician Advisor provides leadership for efficiently managing resource and utilization to deliver quality cost effective care in the most appropriate setting. Works closely with the medical staff leadership, the entire medical staff, including resident physician house staff in all areas of resource/utilization management to develop and implement methods to optimize use of hospital services for all patients. This includes working with hospital leadership in developing care management protocols with physicians and others to optimize efficient management of resources, insuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, performing Peer to Peer reviews, Short Stay Reviews, Extended Observation. Provides for medical staff education and training as required. Provides periodic reports to Board, MEC and Joint Conference as deemed necessary.
-Maintains accountability for achieving utilization / resource management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care -Reviews issues identified by UR staff to ensure appropriate follow-up, recommend improvement initiatives as needed, and make referrals to the appropriate department chair as necessary
-Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Utilization department in a timely fashion
-Provides Peer to peer reviews, and short stay reviews -Provides consultation to nurses and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management -Provides for development and dissemination of 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 topics related to Utilization Management, Care Management and other related areas as requested -Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable -Facilitates local system utilization management training and education to Boards, MEC and medical staff departments as required -Provides for coordination and improvement in QIO audits
-Develops statistical reports related to revenue improvement and denial reduction within scope and as requested by Local System Boards, MEC and other local system committees
-Hold and maintain an unrestricted medical license in the state of the facility / client
-Member of the American College of Physician Advisors (ACPA)
-Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, inc. (ABQAURP)
-Physician Advisor Sub-specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc (ABQAURP)
-Previous managed care medical doctor experience -Poses or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety
-Possess a working knowledge of (Hospital) organization & Case Management operations and administrative standards and policies
-Strong computer skills and working knowledge of the EMR
-Familiarity with MCG/Interqual placement status criteria is preferred -Ability to build rapport with medical staff and hospital leadership to obtain in buy-in and collaboration necessary to achieve desired outcomes
While Ensemble Health Partners is located in Cincinnati, OH - this position has the ability to work remotely.
Internal Number: EHPPA1
About Ensemble Health Partners
Ensemble Health Partners provides revenue cycle management services for our client partner organizations. In healthcare, the only constant is change. Now more than ever, a healthy revenue cycle is essential to survival, requiring innovative approaches and impeccable coordination.
Revenue cycle management plays a major role in running a successful healthcare organization.
As patients become more and more responsible for their healthcare dollars, and reimbursements to hospitals from insurance companies become lower and lower, the need for an efficient and effective revenue cycle management process becomes critical to an organization’s bottom line.
But where some see complexity, we see opportunity. At Ensemble, we’ve assembled a team of talented and passionate operators who know our field firsthand. We partner with our clients, rolling up our sleeves to build real relationships, dig deep into the details and find solutions that deliver results that last.
• 2,000 + associates
• 12 office locations
• 150+ healthcare facilities served
• 29 states with hospital systems we proudly serve
• $230,000 Donated to Charity in 2016/2017