- 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 case with attending physician regarding medical necessity.
- When requested, discuss case with insurance company physician administrator for the purpose of obtaining payer authorization.
- Provide medical expertise, advice 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 colleagues regarding observation status and case management.
- Assist with appeals of denials and participates in data collection activities for resource utilization management.
- Receives daily report form 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 status of the patient.
- Assists with admission, treatment and discharge orders in coordination with the attending physician.
- Conducts interdisciplinary rounds to drive quality and reduce length of stay.
- Interacts regularly with coding and clinical documentation specialists.
- The Physician Advisor would be an active member of the Clinical Resource Management Committee.
- Participates in Payer contract reviews to determine criteria set forth to avoid unnecessary denials.
- Reports data on case management and observation services to the Committee.
- Doctorate in Medicine, MD or DO
- 5 years clinical practice experience in a hospital setting required
- Board Eligible or Board Certified in (insert here)
- PA License
- Physician Advisor experience in clinical setting
- Physician Advisor experience with cross-functional teams
- Physician Advisor experience with large health system
- Physician Advisor experience with integrated payer / provider network
-
Physician Advisor
1 week ago
Ascension Health Birmingham, United States**Details** · **Physician Advisor needed for Ascension St. Vincent's in Birmingham, AL** · + **Schedule:** Full-time · + **Hospital:** Ascension St. Vincent's · + **Location:** Birmingham, AL · **Benefits** · Paid time off (PTO) · Various health insurance options & wellness plans ...
-
Physician Advisor
1 week ago
Ascension Health Birmingham, United StatesDetails · Physician Advisor needed for Ascension St. Vincent's in Birmingham, AL · * Schedule: Full-time · * Hospital: Ascension St. Vincent's · * Location: Birmingham, AL · Benefits · Paid time off (PTO) · Various health insurance options & wellness plans · Retirement benefits i ...
-
Physician Advisor
2 weeks ago
Ascension Birmingham, United StatesDetails · Physician Advisor needed for Ascension St. Vincent's in Birmingham, AL · Schedule: Full-time · Hospital: Ascension St. Vincent's · Location: Birmingham, AL · Benefits · Paid time off (PTO) · Various health insurance options & wellness plans · Retirement benefits includi ...
-
Tenet Healthcare Mountain Brook, United States Full timeCome to Birmingham, Alabama and join the market leader and take your career to the next level. We seek an experienced, board-certified physician to join our administrative team and provide leadership to the Utilization Management Committee (UM), Case Management (CM) and Health In ...
-
Tenet Healthcare Corporation Birmingham, United StatesSeeking a Physician Advisor who has experience with medical staff leadership and a solid understanding of Utilization Management (UM), Case Management (CM), Health Information Management (HIM) and Clinical Documentation Improvement. In this role you will be a member of the hospit ...
-
Tenet Healthcare Corporation Alabaster, United StatesAmazing opportunity to join a thriving national health care system and take your career to the next level We are seeking an experienced, board-certified physician to join our administrative team and provide leadership to the Utilization Management Committee (UM), Case Management ...
-
Certified Medical Assistant
1 day ago
Ascension Homewood, United StatesDetailsDepartment: Urgent Care · Schedule: Two rotating shifts per week 9:00am-9:00pm, Fridays 9:00am-3:00pm or 3:00pm-9:00pm. Every other weekend required 9:00am-6:00pm. · Hospital: Ascension St. Vincent's Urgent Care · Location: Vestavia Hills, AL · CMA certification require ...
-
Medical Assistant
1 week ago
Ascension Cahaba Heights, United StatesDetailsDepartment: CT Surgery · Schedule: Monday - Friday, 8:00am - 4:30pm. No weekends, holidays or on call. · Hospital: Ascension St. Vincent's Cardiothoracic Clinic Patchwork Farms · Location: Vestavia Hills, AL · Experience working in a physician's office or clinical setting ...
-
lpn/lvn
16 hours ago
Ascension English Village, United StatesDetailsSign-on bonus: Up to $8000.00 · Department: Medical Surgical · Schedule: Weekend Options WOW Baylor, hour shifts every weekend · Hospital: Ascension St Vincent's Birmingham · Location: Birmingham, AL · Our Medical Surgical has a 5:1 ratio and 32 beds. There is a stand al ...
-
Registered Nurse RN
16 hours ago
Ascension English Village, United StatesDetailsSign-on bonus: Up to $7,500 · Department: Emergency Department · Schedule: Weekends; Saturday & Sunday - 7a-7p · Hospital: Ascension St. Vincent's Birmingham - Downtown · Location: Birmingham, AL · Benefits Paid time off (PTO) · Various health insurance options & wellnes ...
-
RN Registered Nurse
1 day ago
Ascension English Village, United StatesDetailsSign-on bonus: Up to $15,000 · Department: 5 WEST · Schedule: 3 12 hours 7:00am - 7:00pm - rotating weekends · Hospital: Ascension St. Vincent's Birmingham · Location: Birmingham, AL · 5 West, Cardiac Step-Down is a private 24-bed unit that specializes in cardiac care for ...
-
Registered Nurse RN
1 day ago
Ascension Birmingham, United States Full timeDetailsSign-on bonus: Up to $7,500 · Department: Medical Intensive Care Unit · Schedule: Full-time Day Shift · Hospital: Ascension St. Vincent's Birmingham-Downtown · Location: Birmingham, Alabama · Our 1S ICU, which is also a Medical ICU, has 14 beds. We pride ourselves on team ...
-
Registered Nurse RN
23 hours ago
Ascension Birmingham, United StatesDetails · Want to apply Read all the information about this position below, then hit the apply button. · Sign-on bonus: Up to $7,500 · Department: Medical Intensive Care Unit · Schedule: Full-time Night Shift · Hospital: Ascension St. Vincent's Birmingham- Downtown · Location: Bi ...
-
Registered Nurse RN
23 hours ago
Ascension Birmingham, United StatesDetails · Qualifications, skills, and all relevant experience needed for this role can be found in the full description below. · Department: Float Pool Med Surg · Schedule: Full Time Nights, Twelve Hour Shifts, 7pm to 7am · Hospital: Ascension St. Vincent's Birmingham · Location: ...
-
Registered Nurse RN
23 hours ago
Ascension Birmingham, United StatesDetails · Experience, qualification, and soft skills, have you got everything required to succeed in this opportunity Find out below. · Sign-on bonus: Up to $15,000 · Department: Med Surg Ortho · Schedule: Full Time, Weekends 7am-7pm · Hospital: Ascension St. Vincent's Birmingham ...
-
Registered Nurse
2 weeks ago
Ascension Birmingham, United StatesDetailsSign-on bonus: Up to $15,000 · Department: Med Surg Ortho · Schedule: Full Time, Weekends 7am-7pm · Hospital: Ascension St. Vincent's Birmingham · Location: Birmingham, AL · 5 South is a 30 bed unit specializing in patients undergoing orthopedic and neurosurgical procedu ...
-
Registered Nurse RN
23 hours ago
Ascension Birmingham, United StatesDetails · Before applying for this role, please read the following information about this opportunity found below. · Department: Cardiovascular · Schedule: Full-time Night Shift · Hospital: Ascension St. Vincent's Birmingham - Downtown · Location: Birmingham, Alabama · Provide di ...
-
Registered Nurse RN
1 day ago
Ascension Birmingham, United StatesDetailsSign-on bonus: Up to $15,000.00 · Department: Medical Surgical · Schedule: Full Time FT nights, hour shifts per week, 7pm - 7am · Hospital: Ascension St Vincent's Birmingham · Location: Birmingham, AL · We encourage new grads to apply We have a team of great nurses and ...
-
Registered Nurse RN
1 day ago
Ascension Birmingham, United States Full timeDetailsDepartment: Cardiovascular · Schedule: Full-time Night Shift · Hospital: Ascension St. Vincent's Birmingham - Downtown · Location: Birmingham, Alabama · Provide direct nursing care in accordance with established practices, procedures and protocols of the health-care organi ...
-
Registered Nurse RN
23 hours ago
Ascension Birmingham, United StatesDetails · Interested in this role You can find all the relevant information in the description below. · Sign-on bonus: Up to $7,500 · Department: Emergency Department · Schedule: Full-time Night shift · Hospital: Ascension St. Vincent's Birmingham- Downtown · Location: Birmingham ...
Physician Advisor - Jefferson Hills, United States - Highmark Inc.
Description
Company :
Allegheny Health Network
Job Description :
ESSENTIAL RESPONSIBILITIES:
Physician Advisor - AHN
QUALIFICATIONS:
Minimum
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.
In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct.This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law.
Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity )
We endeavor to make this site accessible to any and all users.
If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please contact HR Services Online atCalifornia Consumer Privacy Act Employees, Contractors, and Applicants Notice
