Physician Advisor Job Burien area,Washington USA,Doctor/Physician

Job Summary and Responsibilities

We are seeking a physician with leadership experience interested in our new Physician Advisor position. This position will work with our St. Anne Hospital in Burien, St. Elizabeth Hospital in Enumclaw, and St. Francis Hospital in Federal Way, WA.

The Physician Advisor serves the Hospital through collaborating with, advising, and teaching the Care Coordination Department; serving as a member of the medical staff; and coordinating with Hospital leadership on matters regarding progression of patient care, medical necessity, compliance with regulatory guidelines, payer relationships; clinical documentation integrity, and identification of trends in the over and under-utilization of resources.

The Physician Advisor should be a key member of the medical staff and take on the role as leader of the Hospital's utilization review/management committee, which is charged with adhering to regulatory requirements while ensuring high levels of healthcare quality and acceptable levels for the cost of care.

The Physician Advisor will conduct clinical reviews on cases referred by case/utilization management and/or other healthcare professionals in accordance with Hospital objectives related to quality care of patients, regulatory compliance, and utilization management (including LOS).

The Physician Advisor should discuss his/her role with the Hospital CMO, or similar position, to clearly define expectations and mentorship opportunities. Specifically, the Physician Advisor will be expected to work in close partnership with Common Spirit Health’s Internal Physician Advisor Services (IPAS) to ensure continuity of services provided.

Additionally, the Physician Advisor will be expected to understand and appreciate the unique elements of a Hospital’s culture, history, and place in the community it serves. All work should be aligned with Common Spirit Health’s Mission, Vision, and Values.

Because of the importance of the role of the Physician Advisor and the visibility this role brings, it is expected that the Physician Advisor has a minimum of 5‑7 years of leadership experience (or equivalent experience) in inpatient and/or advisory settings and possess the appropriate credentials in good standing.

ESSENTIAL JOB FUNCTIONS CLINICAL EFFECTIVENESS

Lead in clinical process design/improvement sessions
Collaborate with stakeholders in the development of a compliant and efficient Care Delivery Model (CDM) VMMC
Provide clinical expertise related to medical necessity claims

Job Title:

Physician Advisor Job Code:
Dept
Collaborate on the development and implementation of standard Clinical Care Pathways for defined diagnoses and DRGs
Review issues identified by Care Coordination to ensure appropriate follow‑up, recommend improvement initiatives as needed and make suggestions to providers and appropriate department chairs as necessary
Provide consultation to Care Coordination staff regarding complex clinical issues and advise on next steps
Document patient care reviews, decisions, and other pertinent information per Hospital/Utilization Management policy

COLLABORATION

Establish and champion successful relationships with Care Coordination (Utilization Management, Denials Management, and Progression/Transition of Care)
Establish partnership and communication channel with attending physicians
Create strategies to enhance Hospital and post‑acute interdisciplinary efforts for maximizing patient/family outcomes
Collaborate with medical staff in the development and measurement of performance standards involving patient care and utilization of resources to achieve optimal outcomes
Notify the case manager of any conflict of interest in reviewing a particular patient record
Collaborate with Care Coordination as needed for Hospital cases that may need issuance of a Hospital notice of non‑coverage.

UTILIZATION MANAGEMENT

Take ownership of onsite Condition Code 44 process
Assist with Readmission reduction - focusing on 30 days, all causes
Assist with the segmentation of concurrent review offerings into Medicare / Medicaid / Commercial Payors, as needed
Reviews medical records of patients identified by case managers/utilization review…


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