Physician Advisor

Job Title: Physician Advisor

Company: WMC Advanced Physician Services, PC

City/State: Valhalla, NY

Category: Allied Health Prof./Technical

Department: Clinical Care Management-WMCHealth

Union: No

Position: Full-time

Hours: M-F 9-5p

Shift: Day

Req #: 38949

Hiring Range: $257,000–$320,000

Job Summary:

The physician advisor is responsible for developing positive relationships with both employed and affiliated medical staff members to fulfill strategic business growth and objectives. This position plays an important role in ensuring physician support and the execution of utilization management and documentation strategies and processes.

Responsibilities:

• Reviews inpatient cases when clinical determinations cannot be made by an initial clinical review.
• Discusses determinations with requesting physicians or ordering providers when available within the regulatory timeframe of the request.
• Provides clinical rationale for standard and expedited appeals.
• Participate in peer-to-peer review with payors and/or complete appeals as required to overturn denials.
• Aids initial clinical reviewers as needed to discuss cases and problems.
• Participates in the daily review of aggregate denials/appeals with the medical director, a peer, or the clinical review supervisor.
• Provides continuous education to physicians as needed on payer policies and workflows.
• Utilizes medical review guidelines and parameters to assure consistency in the review process to reflect appropriate utilization and compliance with various organizations.
• Documents all communications with providers and records in a timely and accurate manner.
• Functions as a resource for initial clinical reviewers.
• Serves on the UM Committee.
• Provides physician administrative support and leadership in the utilization and resource management areas of integrated case management, including mentoring/coaching care coordinators, utilization review staff and social workers.
• Reviews cases for medical necessity
• Conducts daily multidisciplinary rounds with a focus on reducing LOS and readmissions.
• Collaborates with hospitalists, physicians, and house staff in determining appropriate inpatient versus outpatient/observation status and providing feed-back on documentation improvement.
• Participants in third-party payor denial, appeal, and peer-to-peer processes using MCG/InterQual criteria/guidelines.
• Performs other duties as assigned.

Experience:

Experience as a CDI champion and/or case management physician advisor or having 3-5 years as a physician reviewer/advisor with a third-party leveling and/or appeals agency is preferred. Previous utilization management, case management or peer review documentation experience in hospitals or health plans is preferred. Five years of clinical hospital experience are preferred. Five years of experience in internal medicine, providing direct patient care, is preferred. Knowledge of MCG guidelines is preferred. Experience with Allscripts/Cerner is preferred.

Education:

A graduate of an accredited medical school is required. MD with board eligibility is required.

Licenses/Certifications:

Current unrestricted MD license to practice medicine. Board certification by the American Board of Medical Specialties (ABMS) or the American Board of Osteopathic Specialties (ABOS) is preferred.

Other:

Has the ability to travel among the Westchester Medical Center Health Network (WMCHealth) hospitals on a regular basis.

Benefits:

We offer a comprehensive compensation and benefits package that includes:

• Health Insurance
• Dental
• Vision
• Retirement Savings Plan
• Flexible Savings Account
• Paid time off
• Holidays
• Tuition Reimbursement

WMCHealth is an Equal Opportunity Employer. It is the policy of Westchester Medical Center Health Network to provide equal employment opportunities without regard to race, color, religion, gender, national or ethnic origin, sex, sexual orientation, gender identity or expression, age (40 or older), marital status, genetic information or carrier status, disability (mental or physical), citizenship status, pregnancy, military service or veteran status, arrest or criminal accusation, domestic violence victim status or any other status protected by federal, state, or local law.