Allegheny Health Network
Healthcare
PhysicianAdvisor
Neural analysis suggests this role is
optimal for Senior candidates.
“Physician Advisor at Allegheny Health Network. Skills: Assures the most cost-effective, appropriate use of health care services, Correlating patient clinical information with both government and commercial payer utilized regulations and criteria regarding severity of illness, intensity of service, and the appropriateness of the setting for the administration of that care, Level of care reviews, Peer-to-peer discussions with payers, Collaboration with the hospital’s interdisciplinary care team, U”
What You'll Achieve.
Assures the most cost-effective, appropriate use of health care services; Drive quality and reduce length of stay; Implement action plans if not meeting goals
Industry & Context.
Assures the most cost-effective, appropriate use of health care services; Correlating patient clinical information with both government and commercial payer utilized regulations and criteria regarding severity of illness, intensity of service, and the appropriateness of the setting for the administration of that care; Level of care reviews; Peer-to-peer discussions with payers; Evaluate the medical necessity and appropriateness of admission to the hospital, utilization of observation status and services for those patients, continued stay in the hospital, and ancillary services ordered; Obtain payer authorization or conduct a peer-to-peer discussion in cases of a denial; Facilitates use of institutional processes; Drive quality and reduce length of stay; Review and analyze metric reporting dashboards and implement action plans if not meeting goals
Position requires onsite hospital presence
What They're Looking For.
Must Have
5 years of clinical practice experience in a hospital setting required, Doctor of Medicine (MD) or Doctor of Osteopathy (DO), Board Certified in any Medical Subspecialty, Licensed in the state of Pennsylvania prior to employment
Nice to Have
Board Certified in Quality/Physician Advising, Physician Advisor experience in a clinical setting, Physician Advisor experience with cross-functional teams, Physician Advisor experience with large health system, Physician Advisor experience with integrated payer/provider network
What You'll Do.
Assures the most cost-effective
appropriate use of health care services for patients treated at Allegheny Health Network
Correlates patient clinical information with both government and commercial payer utilized regulations and criteria regarding severity of illness
and the appropriateness of the setting for the administration of that care
Responsible for level of care reviews and peer-to-peer discussions with payers if denials do arise
Works in concert with the admitting physician
and other hospital personnel
to evaluate the medical necessity and appropriateness of: admission to the hospital
utilization of observation status and services for those patients
continued stay in the hospital
and ancillary services ordered
discuss the case with the attending physician regarding medical necessity
discuss the case with the insurance company medical director to obtain payer authorization or conduct a peer-to-peer discussion in cases of a denial
Provide medical expertise
and support to the Case Management Department
Provide education to the medical staff regarding medical necessity and appropriateness of health care services
Provides ongoing education to residents/colleagues regarding observation status and case management
Assists with appeal letters and participates in data collection activities for utilization management
Receives daily report from Nursing Service (Bed Management) and Case Management on all observation cases
Reviews the status of observation cases
facilitates use of institutional processes and communicates with attending physicians and case managers regarding the patient's status
Conducts interdisciplinary rounds to drive quality and reduce length of stay in concert with case management
and the rest of the multidisciplinary team
Interacts regularly with coding and clinical documentation specialists
Required to be an active member of the Utilization Management Committee
Leads and reports data on case management and observation services on the monthly Throughput Meeting
Needs to be able to review and analyze metric reporting dashboards and implement action plans if not meeting goals
How You'll Work.
Team & Collaboration
Significant collaboration with the hospital’s interdisciplinary care team including Physicians, Case Managers, UM nurses, and the hospital leadership team; Works in concert with the admitting physician, Case Management, and other hospital personnel; Discuss the case with the attending physician regarding medical necessity; Discuss the case with the insurance company medical director; Provides ongoing education to residents/colleagues; Communicates with attending physicians and case managers regarding the patient's status; Conducts interdisciplinary rounds to drive quality and reduce length of stay in concert with case management, physicians, and the rest of the multidisciplinary team; Interacts regularly with coding and clinical documentation specialists; Physician Advisor experience with cross-functional teams; Physician Advisor experience with integrated payer/provider network
Communication Scope
Peer-to-peer discussions with payers; Discuss the case with the attending physician regarding medical necessity; Discuss the case with the insurance company medical director; Communicates with attending physicians and case managers regarding the patient's status
Process & Methodology
Implement action plans if not meeting goals
Full Job Description
## **Company :** Allegheny Health Network ## **Job Description :** The **Allegheny Health Network (AHN)** is recruiting a full-time **Physician Advisor** to join our team located in**Erie, PA.** **General Overview:** This job assures the most cost-effective, appropriate use of health care services for patients treated at Allegheny Health Network while correlating patient clinical information with both government and commercial payer utilized regulations and criteria regarding severity of illness, intensity of service, and the appropriateness of the setting for the administration of that care. The Physician Advisor is responsible for level of care reviews and peer-to-peer discussions with payers if denials do arise. The role requires significant collaboration with the hospital’s interdisciplinary care team including Physicians, Case Managers, UM nurses, and the hospital leadership team. The Physician Advisor is an integral part of the Utilization Management Committee and participates in hospital and enterprise-level quality and throughput initiatives. This position reports to the Chief Quality Officer and Medical Director of Physician Advisors. **Duties:** * Position requires onsite hospital presence * The Physician Advisor works in concert with the admitting physician, Case Management, and other hospital personnel, to evaluate the medical necessity and appropriateness of: admission to the hospital, utilization of observation status and services for those patients, continued stay in the hospital, and ancillary services ordered. When appropriate, discuss the case with the attending physician regarding medical necessity. * When requested, discuss the case with the insurance company medical director to obtain payer authorization or conduct a peer-to-peer discussion in cases of a denial. * Provide medical expertise, advice, and support to the Case Management Department. * Provide education to the medical staff regarding medical necessity and appropriateness of health car
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