Physician Advisor Needed for Scenic City Chattanooga, TN

Erlanger is a nationally-acclaimed health system anchored by a leading academic medical center. Through innovation and growth, we will sustain our success and spark economic development across the Chattanooga region.

• Participate in peer-to-peer discussions with managed Medicaid, managed Medicare and commercial insurance medical directors.
• Provide subject matter expert guidance regarding utilization management activities that involve admission status, medical necessity, CC44, OC72, the two-midnight rule, etc. This guidance will be supported by clinical evidence and will be compliant with applicable governmental rules and regulations.
• Work with IT to ensure logical processes, best practices, and compliance with CMS regulations.
• Promote professional development of the UM staff with a focus on compliant patient status assignments, consistent use and documentation of primary screening criteria (MCG and Indicia), knowledge of the most recent IPO procedure list, IPPS and OPPS annual changes and how they impact status determination, charges, reimbursement, and interrater reliability of the Physician Advisors.
• Work collaboratively with Revenue Integrity to reduce denial and appeal burdens and increase revenue by improving the accuracy of initial patient status determinations.
• Interface with Compliance as a subject matter expert for government regulations and annual audits.
• Assist with the development and driving of improvement initiatives including providing feedback to medical staff regarding utilization management determinations.
• Pursue positions as a member of strategic committees outside the organization that will assist the Authority to be aware of current trends, compliance with regulatory guidance, and influence of state­ and national policy, including:
  • ACPA (American College of Physician Advisors)
  • MCG (Physician Advisors Council)
  • ABQAURP (American Board of Quality Assurance and Utilization Review Physicians)
• Serve as member of the URC (Utilization Review Committee).
• Serve as member of the Outlier and Recertification meeting.
• Provide secondary level physician reviews and continuing stay reviews.
• When available, participate in IDR (interdisciplinary rounds) to advise on the improvement of clinical resource utilization and throughput.
• Assist with training of all new UM department hires.
• Perform such other duties as reasonably requested by Erlanger or otherwise necessary to properly assist in the operations of assigned areas.

Education/Experience: 

A minimum of 5 years of clinical practice in field of specialty or previous work as a Physician Advisor. M.D. or D.O. degree.  Completion of an approved residency and, if applicable, fellowship program.

Licensure: 

Licensed to practice in the State of Tennessee.

Certification: 

Board Certification in practice specialty.

ACPA-C credential or willing to obtain certification as a physician advisor (ACPA-C) by the American College of Physician Advisors

Willing to obtain CHCQM-Board Certified in Health Care Quality Management

Willing to obtain CHCQM-PHYADV- subspecialty Board Certification as a Physician Advisor in HCQM

Erlanger Health -

 Erlanger Health  is a multi-hospital system with six hospitals based in Chattanooga, and is the tristate region's only Level I Trauma Center, providing the highest level of trauma care for adults. Erlanger also serves as the region's only academic teaching hospital, affiliated with the University of Tennessee College of Medicine Chattanooga.  With a history that dates back more than a century, Erlanger is the 7th largest public hospital in the U.S., and recognized as one of the nation's finest public hospitals and a leader in healthcare.

Chattanooga “The Scenic City”

Chattanooga, the 4th largest city in the state, a top 25 place to visit in 2018, is located in Southeast Tennessee near the border of Georgia. The city has received national recognition for the renaissance of its beautiful downtown and redevelopment of its riverfront. Most striking, though, is the city’s civic life. A phrase that comes up constantly is “The Chattanooga Way”: a reference to a cooperative get-it-done attitude.

With its scenic beauty, stable population and economy, civic vitality and cross-sector partnerships, fiscal integrity, and strategic location, Chattanooga enters the 21st century as one of the most progressive and livable mid-size cities in the US. Attractions such as the Tennessee Aquarium, Lookout Mountain, Civil War battlefield sites, the Hunter Art Museum, and the Appalachian Trail bring thousands of people to the area, as do the many creative multicultural events throughout the year.