Physician Advisor

Overview

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

POSITION PURPOSE/

SUMMARY:

• Purpose:
  
  Provides physician leadership and expertise related to care coordination, length of stay (LOS)/level of care (LOC) management, care variation management, patient flow/throughput management, ancillary service utilization (e.g., lab and radiology) and clinical documentation improvement (CDI).
• Policy-Setting Responsibilities:
  Responsible for reviewing and providing physician perspective for policies that relate to care coordination, care progression, patient access, care variation management and CDI.
• Decision-Making Authority:
  Responsible for collaborating with the care coordination, nursing, patient access, ancillary services, and CDI departments to meet established goals and for leading physician participation and compliance with responsibilities.
• Supervisory Responsibility:
  Responsible for engaging physicians in care coordination, care progression, patient access, care variation management and CDI activities in alignment with the Physician Advisor’s assigned facility, as well as to support system-level goals.

DUTIES AND RESPONSIBILITIES:

Inpatient Clinical Optimization:
Care Coordination, Progression and Variation

• Serves as physician expert and provides support to care team and care coordination staff regarding utilization decisions including screening for appropriateness of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource utilization/management, denial management issues, discharge planning (DP) advice, and quality issues.
• Maintains knowledge of government regulations related to utilization review, transition planning, billing, and managing patients and acts as a resource to physicians and staff related to these regulations.
• Perform second level reviews, peer-to-peer calls and advise on continued stay reviews that require additional Physician Advisor input.
• Management of appeals process, post-discharge review, and necessary documentation improvement.
• Interacts with medical staff by seeking additional clinical information from physicians, discussing patients’ needs, suggesting alternative treatment options, and recommending next steps.
• Functions as a consultant and resource to primary (attending) physicians. Reinforces evidenced-based medicine best practices and adherence to reduction in clinical variation.
• Supports care team, patient placement department and nursing supervisors by assisting with patient placement decisions (as needed), care/discharge delays, and patient throughput.
• Provides support to ancillary services departments (e.g., lab and radiology) by mitigating the inappropriate or unnecessary use of services.
• Participates in daily Escalation Huddles to support care team communication and coordination activities, and to discuss selected cases (e.g., outliers or care/discharge barriers) and makes recommendations regarding care.
• Prepares for and participates in (or ideally, leads) monthly Utilization Management (UM) Committee.
• Documents patient care reviews, determinations, and other pertinent information per…