Physician Advisor - GILBERT, United States - CommonSpirit Health

Description

Dignity Health's Mercy Gilbert Medical Center is nationally known for our holistic approach to medicine, and here, you are a part of a "golden thread" of compassionate care that connects staff and patients. While walking through the Healing Garden–with it's intertwined pathways, garden areas and fountains–you're reminded of our dedication to honoring the whole person. Embracing total well-being, then seeing patients and their loved ones respond positively, is personally rewarding to you. Dignity Health is one of the largest healthcare systems in the West with over 40 hospitals in Arizona, California and Nevada. Mercy Gilbert is a modern, 212-bed, acute care, not-for-profit community hospital in the Phoenix area's East Valley. We offer a full breadth of care, from emergency and cardiovascular to pediatric, orthopedic and diagnostic services. Since opening in June 2006, we have been named the "#1 Small-Sized Acute Care Hospital" by Arizona Business Magazine and the "#1 Healing Hospital in the Nation" by Baptist Healing Trust.

We've also been named "Business of the Year" by the Gilbert Chamber of Commerce. You're proud of these awards, but even more, you're proud of the solace, serenity and reprieve you're able to provide here. Living in Phoenix's relatively new suburb of Gilbert, Arizona, you treasure its old-world charm mixed with modern-day luxuries. This urban center has all the shopping, restaurants and culture your heart desires, with all the outdoor activities your spirit needs. There are nearby lakes for boating, wakeboarding and water skiing, while Flagstaff and Sunrise offer winter skiing and snowboarding. Arizona has four professional sports teams, and you're a year-round fan. You look forward to all the activities, but then again, at the end of a busy day, taking a moment to relax poolside and reflect. The scenery, the climate and the culture present the perfect backdrop for your healing work at Mercy Gilbert. Now is the perfect time to come grow your career with one of Arizona's Most Admired Companies.

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Job Summary:

The Physician Advisor plays a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of hospital resources for our Mercy Gilbert and Chandler Regional Medical Center locations. The position's emphasis is on facilitating communication between the Department of Care Coordination, Medical Staff, Nursing Staff, and Administration regarding systems-based practice, regulatory and quality considerations in the delivery of medical care. Performs the duties of this role according to the organizational objectives, hospital policies, standards of practice and Federal and State regulations.

Job Standards:

• Mitigate denials for payment from insurance payers by providing valid and effective secondary medical necessity reviews. Review and report performance measures and make recommendations to Departments and the Medical Executive Committee regarding opportunities for improvement of patient care, resource utilization, billing compliance and reduction of claims denials.
• Provide compliance element for Centers for Medicare and Medicaid Services (CMS)Conditions of Participation (COP) by performing secondary medical necessity reviews.
• Provide a more cost-effective delivery of secondary medical necessity reviews than what is currently provided by outside contracted services (Executive Health Resources (EHR).
• Champion good stewardship of resources.

Inpatient Facilities:

• Align and collaborate with the facility leadership.
• Understand and appreciate unique elements of facility history and culture in order to effectively execute/implement job duties and functions.
• Act as a resource for work teams that align with facility utilization initiatives (i.e. leverage the leadership influence of Physician Advisor by mobilizing other physicians and staff). Provide education to medical staff colleagues regarding best practices, the utilization review process, regulatory issues, use of clinical guidelines, and appropriate levels of care.
• Optimize revenue capture by providing oversight for appropriate status determinations.
• Provide compliance element for CMS Conditions of Participation by active involvement in the facility utilization management processes.
• Optimize cost of care by providing oversight for appropriate level of care determinations. Serve as resource for Care Coordination by determining the appropriateness of the referrals, applying professional judgment in the context of patientrelated variables, and consulting with attending physicians, residents, and other health professionals as needed in order to clarify issues regarding appropriateness of level of care, care alternatives, and resource utilization.

Inpatient Facility Care Coordination:

• Provide advisory support to staff in their care transition challenges. Advocate for and facilitate quality patient care by identifying systems barriers, practice variances or resource challenges that impede, delay or interfere with efficient, effective and appropriate health care delivery.
• Engage physician staff in discussions concerning transitions of care.
• Engage physician staff in discussions concerning utilization of resources. Facilitate the timely prospective, concurrent, or retrospective review of resource use in referred cases, with the objective of optimizing length of stay and reducing avoidable days and claim denials.
• Influence physician practices to optimize documentation for medical necessity staff.
• Complete medical necessity reviews for status determinations and levels of care as tasked by care coordination staff during standard business days / hours.
• Provide medical necessity documentation for status determination changes as encountered on facility patient care units.

Minimum Qualifications Required:

Education:

• Medical degree or DO degree with active medical license.

Experience:

• Minimum of five years clinical practice experience.
• Active member in good standing of Hospital's medical staff and participating member of various medical committees.

Licensure:

• Licensed to practice medicine without restrictions in the State where performing Physician Advisor duties; MD AZ or DO AZ.

Special Skills:

• Strong clinical judgment and technical abilities.
• Strong collaboration skills with other physicians.
• Excellent interpersonal and communication skills.

Training:

• Knowledgeable in basic principles of utilization management and quality assessment.

We offer the following benefits to support you and your family:

• Medical/Dental/Vision Insurance (no premium for employee benefits)
• Flexible spending accounts
• Matching 403(b) retirement program
• Fully Funded Pension Plan
• Paid Time Off (PTO)
• Tuition Reimbursement
• Employee Assistance Program (EAP)
• Employee Life Insurance
• Annual Performance Bonus
• Relocation assistance as needed
• Dignity Health now offers an Education Benefit program for benefit-eligible employees after 180 days. This program provides debt relief and student loan assistance to help you achieve your goals. Full-time employees can receive up to $18,000 over five years, while part-time employees can receive up to $9,000. Advanced Practice Providers and Faculty Physicians can receive up to $90,000 if full-time and hired within a year of completing their residency or fellowship. Part-time providers can receive up to $45,000. Join our team at Dignity Health to take advantage of this amazing opportunity

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