Physician Advisor
Overview At Dignity Health, living our values means bringing passion into action every day.
Dignity Health-Yavapai Regional Medical Center (DH-YRMC), now part of CommonSpirit Health, is a not-for-profit integrated healthcare provider that offers a broad range of inpatient and outpatient services including network-wide opportunities to advance your career.
Dignity Health-Yavapai Regional Medical Center is a not-for-profit integrated healthcare provider that offers a broad range of inpatient and outpatient services.
Our healing network includes two full-service acute care hospitals that include outpatient service centers and primary and specialty care clinics.
We also have advanced centers for IV wound and breast care.
YRMCs unmatched continuum of care covers a 5,500 square mile service area and includes cardiac surgery, neurosurgery, a comprehensive Women's Health Pavilion, and Arizona's only Patient Blood Management Program.
YRMC has earned numerous awards for quality and has earned national recognition as an exceptional provider of care.
Dignity Health-Yavapai Regional Medical Center extends this feeling with a strong sense of family, security, and belonging.
Our compassion and commitment to quality care has earned awards, such as the Stroke Care Excellence Award (2022), Neuroscience Excellence Award (2021, 2020) and America's 100 Best Hospitals for Stroke Care Awards (2020, 2021) and has placed us at the top of the charts in community and nationwide in healthcare.
Come experience the incredible quality-of-life that Dignity Health-YRMC and Prescott AZ has to offer! As you build your career at DH-YRMC, you'll find Prescott AZ is an inspiring place to live, work and to enjoy the outdoors.
It is an inviting community with bygone charm and modern amenities.
Local residents enjoy four spectacular seasons, while the area offers nearly year-round sunshine for any outdoor adventures.
The carefree, relaxed lifestyle offers short commute opportunities, so you can focus on your career and your family.
Look for us on Facebook and follow us on Twitter.
For the health of our community we are proud to announce that we are a tobacco-free campus.
www.
yrmc.
org #hellohumankindness Responsibilities Position
Summary:
Reporting to our CMO, the Physician Advisor plays a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of hospital resources.
This newly created 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 StandardsCorporate/System-wide:
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:
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.
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.
Provide compliance element for CMS Conditions of Participation by active involvement in the facility utilization management processes.
Work with Chiefs of Staff / CMO's to obtain membership on the Medical Staff, Medical Executive Committee (MEC), and assist in facilitation on Facility Utilization Management Committee.
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.
Champion best practices among Care Coordination.
Qualifications Minimum
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.
Minimum Education:
Doctor of Medicine (MD or DO).
Minimum Licensure:
Licensed to practice medicine without restrictions in the State where performing Physician Advisor duties:
MD:
AZ or DO:
AZ.
Minimum Special Skills:
Strong clinical judgment and technical abilities.
Strong collaboration skills with other physicians.
Excellent interpersonal and communication skills.
Minimum 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 option for employee benefits) Flexible spending accounts Matching 403(b) retirement program Fully Funded Pension Plan Paid Time Off (PTO) Tuition Reimbursement Mental Health benefit Employee Life Insurance Annual Performance Bonus eligibility Relocation assistance as needed #LI-DH Recommended Skills Administration Billing Care Coordination Claim Processing Clinical Practices Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
Dignity Health-Yavapai Regional Medical Center (DH-YRMC), now part of CommonSpirit Health, is a not-for-profit integrated healthcare provider that offers a broad range of inpatient and outpatient services including network-wide opportunities to advance your career.
Dignity Health-Yavapai Regional Medical Center is a not-for-profit integrated healthcare provider that offers a broad range of inpatient and outpatient services.
Our healing network includes two full-service acute care hospitals that include outpatient service centers and primary and specialty care clinics.
We also have advanced centers for IV wound and breast care.
YRMCs unmatched continuum of care covers a 5,500 square mile service area and includes cardiac surgery, neurosurgery, a comprehensive Women's Health Pavilion, and Arizona's only Patient Blood Management Program.
YRMC has earned numerous awards for quality and has earned national recognition as an exceptional provider of care.
Dignity Health-Yavapai Regional Medical Center extends this feeling with a strong sense of family, security, and belonging.
Our compassion and commitment to quality care has earned awards, such as the Stroke Care Excellence Award (2022), Neuroscience Excellence Award (2021, 2020) and America's 100 Best Hospitals for Stroke Care Awards (2020, 2021) and has placed us at the top of the charts in community and nationwide in healthcare.
Come experience the incredible quality-of-life that Dignity Health-YRMC and Prescott AZ has to offer! As you build your career at DH-YRMC, you'll find Prescott AZ is an inspiring place to live, work and to enjoy the outdoors.
It is an inviting community with bygone charm and modern amenities.
Local residents enjoy four spectacular seasons, while the area offers nearly year-round sunshine for any outdoor adventures.
The carefree, relaxed lifestyle offers short commute opportunities, so you can focus on your career and your family.
Look for us on Facebook and follow us on Twitter.
For the health of our community we are proud to announce that we are a tobacco-free campus.
www.
yrmc.
org #hellohumankindness Responsibilities Position
Summary:
Reporting to our CMO, the Physician Advisor plays a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of hospital resources.
This newly created 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 StandardsCorporate/System-wide:
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:
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.
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.
Provide compliance element for CMS Conditions of Participation by active involvement in the facility utilization management processes.
Work with Chiefs of Staff / CMO's to obtain membership on the Medical Staff, Medical Executive Committee (MEC), and assist in facilitation on Facility Utilization Management Committee.
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.
Champion best practices among Care Coordination.
Qualifications Minimum
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.
Minimum Education:
Doctor of Medicine (MD or DO).
Minimum Licensure:
Licensed to practice medicine without restrictions in the State where performing Physician Advisor duties:
MD:
AZ or DO:
AZ.
Minimum Special Skills:
Strong clinical judgment and technical abilities.
Strong collaboration skills with other physicians.
Excellent interpersonal and communication skills.
Minimum 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 option for employee benefits) Flexible spending accounts Matching 403(b) retirement program Fully Funded Pension Plan Paid Time Off (PTO) Tuition Reimbursement Mental Health benefit Employee Life Insurance Annual Performance Bonus eligibility Relocation assistance as needed #LI-DH Recommended Skills Administration Billing Care Coordination Claim Processing Clinical Practices Clinical Works Estimated Salary: $20 to $28 per hour based on qualifications.
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