Deaconess Health System in Evansville, Indiana seeks a high caliber Physician Advisor. The health system encompasses six hospitals, the Deaconess Clinic, a fully integrated multispecialty group, as well as multiple care sites and partnerships with other community health care providers. With a total of 722 licensed beds and $866 million in operating revenues, Deaconess has become the premier provider of health care services to three states and 26 counties.
The Physician Advisor (PA) conducts clinical reviews on cases referred by case management staff and/or other health care professionals to meet regulatory requirements and in accordance with the Deaconess Health System (DHS) objectives for assuring quality patient care and effective, efficient utilization of health care services. The PA meets with case management and health care team members to discuss selected cases and suggest care alternatives, interacting with medical staff members and medical directors of third party payers to discuss the needs of patients and alternative levels of care. The PA acts as a consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalizations, continued stay and resource usage. The PA further acts a resource for the medical staff regarding federal and state utilization and quality regulations.
Acute Inpatient/Case Management Functions
· Reviews medical records of patients identified by case managers or as requested by the healthcare team:
o Assist with level of care and length of stay management
o Assist with the denial management process
o Review and suggest improvements related to resource and service management
o Assist staff with clinical review of patients
o Determine if professionally recognized standards of quality care are met
· Provides feedback to attending and consulting physicians regarding above. Recommends next steps in coordination of care and evidence based medicine indicators
· Review cases that indicate a need for issuance of a hospital notice of non-coverage from Medicare. Discuss the case and educate the attending on the process of issuance and appeal as needed.
· Support UR staff and floor case managers in issue resolution. Acts as a liaison between UR/Case Management and providers to collaborate on appropriate plans of care
· Supports the peer review process
· Identify conflicts of interest in reviewing patient records and assign a reviewing physician as appropriate
· Acts as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate
· Participates in the review of long stay patients with case management and the multidisciplinary team. Participates in patient rounds as needed.
· Provides guidance to ED Physicians and case management regarding issues and alternatives to acute care when not warranted
· Works with case management and the interdisciplinary team to ensure appropriate continuity of care and reduce readmissions
Deaconess was founded in 1892 by a group of Protestant ministers and laymen who felt called to care for the sick. More than 125 years later, Deaconess Health System has become the premier provider of health care services to a 26-county, tri-state area in southwestern Indiana, western Kentucky and southeastern Illinois. The system is comprised of six hospitals located on 4 campuses in Southern Indiana.
Doctor of Medicine or Doctor of Osteopathy degree from an approved College of Medicine/Osteopathy.
5 years’ experience as a physician.
Administrative experience on Medical Staff and Hospital Committees or administrative roles, preferred.
Experience as a Physician Advisor in the acute care setting and/or the payer environment, preferred.
Education and experience in the areas of medical management, outcomes management, and quality improvement/patient safety, preferred.
Working knowledge of admission and discharge criteria such as InterQual and Milliman, along with a solid foundation in MS-DRG, APR, DRG, AP-DRG systems and ICD-10-CM are preferred.
Board Certified/Eligible physician licensed for the practice of medicine in the State of Indiana.
Certification by American Board of Quality Assurance & Utilization Review Physicians (ABQAURP), preferred.
How to apply
Please email CV to Bob Scheller, Human Resources, email@example.com
600 Mary St. Evansville, IN 47747, 812-450-2362