Physician Advisor Position Available In Rockland, New York

Summary:

The Physician Advisor is responsible for developing positive relationships with both employed and affiliated medical staff members in order to fulfill strategic business growth and objectives. This position manages interactions with physicians and practice managers in a provider or acute care setting in multiple counties within the Hudson/Delaware Valley of New York, New Jersey and Pennsylvania.

Responsibilities:

Reviews inpatient cases when clinical determinations cannot be made by initial clinical review. Discusses determinations with requesting physicians or ordering providers when available within the regulatory timeframe of the request Provides clinical rational for standard and expedited appeals. Participate in peer to peer review with payors and/or complete appeals as required to overturn denials Provides assistance to initial clinical reviewers as needed to discuss cases and problems. Participates in daily review of aggregate denials/appeals with the Medical Director, peer, or the Clinical Review Supervisor. Provides continuous education to physicians as needed on payor policies and workflows Utilizes medical review guidelines and parameters to assure consistency in the review process to reflect appropriate utilization and compliance with various organizations Documents all communications with provider and records in a timely and accurate manner. • Functions as a resource for initial clinical reviewers. Serves on UM Committee • Provides Physician administrative support and leadership to the utilization and resource management areas of Integrated Case Management including mentoring/coaching care coordinators, utilization review staff and social workers. Reviews cases for medical necessity Conducts daily multidisciplinary rounds with focus on reducing LOS and readmissions. Collaborates with hospitalists, physicians, and house staff in determining appropriate inpatient versus outpatient/observation status, and providing feed-back on documentation improvement Participants in third-party payor denial, appeal and peer- to- peer processes using MCG/Interqual criteria/guidelines.

Qualifications/Requirements:

Experience:

5-7 years of Clinical Hospital Experience preferred. 5-7 years of experience in Cardiology, imaging, medical and / or surgical specialty and providing direct patient care preferred.

Education:

Graduated from an accredited Medical School required. Licenses /

Certifications:

MD with Board eligibility required. Current Unrestricted MD License to practice medicine. Board Certified by the American Board of Medical Specialties (ABMS) or the American Board of Osteopathic Specialties (ABOS) preferred