Physician Advisor

• Are you an experienced MD or DO with current licensure in the state of Nebraska?
• Do you have EPIC or large scale EMR experience?
• Do you have a passion for high quality care and Utilization Management?
• Are you willing to learn or already are and expert with CMS rules and regulations?

The Physician Advisor works closely with the Chief Medical Officer, medical staff, medical residents and fellows, and other leadership related to case/utilization management and revenue cycle.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Reviews medical records of patients referred by Care/Utilization Managers to perform quality, utilization, and patient status oversight.

3. *Evaluates medical records of patients referred by Care/Utilization Managers and discusses with consulting and attending clinicians to determine medical necessity of hospital care and provision of services. Acts as the primary conduit between attending physicians and Care/Utilization Management staff ensuring Inpatient hospitalizations meet medical necessity criteria.

4. *Investigates avoidable delay concerns referred by Care/Utilization Managers regarding patient outcomes during their hospital stay.

5. *Chairs the Utilization Review Committee

6. *Collaborates with Utilization and Care Management leadership to optimize case/utilization management workflows.

7. *Performs Medicare short-stay reviews for potential Part B re-billing.

8. *Serves as the hospital expert in determination of patient status for all payors.

9. *Recommends and requests additional and more complete medical record documentation from clinicians to support medical necessity when needed.

10. *Works with Care/Utilization Managers when needed regarding delivery of Medicare Advanced Beneficiary Notices (ABNs), Hospital-Issued Notices of Noncoverage (HINNs), or other patient notices regarding patient financial responsibility.

11. *Prepares for and participates in payor medical director peer-to-peer discussions.

12. *Develops and maintains effective working relationships with payer medical directors involved in peer-to-peer discussions.

13. *When requested, participates in review of long stay/complex patients, in conjunction with the Care Management team, clinicians caring for the patient, and other members of the multidisciplinary team to establish optimal care and discharge planning.

14. *Collaborates with other hospital leaders regarding trends related to quality, safety, and efficiency issues potentially leading to delivery of suboptimal care.

15. *Supports the organization in quality improvement efforts requiring clinician input and/or involvement.

16. *Participates in all organizational efforts to reduce hospital readmissions.

17. *Educates clinical providers regarding payor and CMS requirements including inappropriate hospitalizations, inappropriate Inpatient status designations, and payor and CMS criteria involving medical record documentation, appropriate utilization of hospital services, and alternative levels of care.

18. *Reports practice pattern trends and opportunities to the chief medical officer.

19. *Works with inpatient clinical clinician leadership to ensure effective communication throughout the day.

EDUCATION AND EXPERIENCE:

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school required. Current licensure in the State of Nebraska required. Board certification in clinical area of expertise required. Minimum of three years of experience in clinical practice, preferably in an inpatient hospital setting required. Minimum of two years experience using a large-scale EMR platform (e.g., EPIC) preferred. Minimum of three years of experience working in a multispecialty group practice preferred.

OTHER CREDENTIALS / CERTIFICATIONS:

American College of Physician Advisors Certified (ACPA-C) within six months of hire if not already attained.

Certification with the U.S. Drug Enforcement Administration for prescriptive authority required.

Basic Life Support (CPR) certification is required. Bryan Health recognizes the American Heart Association (for healthcare professionals), the American Red Cross (for healthcare professionals), and the Military Training Network.