Penn Medicine Physician Advisor

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

The Physician Advisor is a key member of the healthcare organization's leadership team and is charged with meeting the organization's goals and objectives for assuring the effective and efficient utilization of health care services. The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. The Physician Advisor shall possess and/or develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, and appropriate physician documentation requirements.

Reporting directly to the Chief Financial Officer, the Physician Advisor works closely with medical staff leadership, medical staff, and all areas of resource management, case management, social services, discharge planning, and utilization management to develop and implement methods to optimize use of hospital services.

Responsibilities:

• Make recommendations on level of care including initial level of care, secondary review, and as requested by case management

• Review for daily level of care recommendations on cases placed in Observation

• Participate in the denials management process

• Be a leader in optimizing denial management

• Perform peer to peer appeals and draft appeal letters for third party denials where appropriate

• Apply the 2 midnight rule to Medicare reviews

• Maintain compliance with Medicare rules as it applies to level of care recommendations

• Stay current on changes in payer rules including CMS rules as it pertains to utilization review

• Recommend and request additional and more complete medical record documentation from providers to support placement status or medical necessity

• Understand and use InterQual and/or other appropriate criteria

• Apply medical expertise to assist with appropriate billing for services

• Provide feedback to Contracting on payer denial patterns where appropriate

• Facilitate, mentor, and educate other physicians regarding documentation and payer requirements.

• Facilitate, mentor, and educate case management on the utilization review process where appropriate

• Chair, or assist the Lead Physician Advisor in chairing, the Utilization Committee

• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures

• Other duties as assigned to support the unit, department, entity, and health system organization

Education/Experience:

• MD or DO (required)

• Minimum 5 years clinical experience in a hospital setting (required)

• Possess or develop a solid foundation in the areas of utilization management and hospital operations (required)

• Master of Business Administration (MBA), Master of Medical Management (MMM), or similar degree (preferred)

Certifications:

• Possess and maintain an unrestricted medical license in the State of Pennsylvania (required)

• American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Health Care Quality and Management (HCQM) certification (preferred)
• American College of Physician Advisors certification (ACPA-C) (preferred)We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.