Applicants may apply for this position online or submit a resume/ CV to the following email address : MD[email protected]
When submitting a resume/CV by email, you must include the job title and posting number in the subject line of your email . An application or resume/CV must be filed for each position which interests you.
To receive Veteran Preference, appropriate discharge papers must be attached to the online application or must be included with your emailed resume/CV. Please refer to Veteran Preference document requirements listed on the bottom of this posting.
The Physician Advisor will assure effective and efficient delivery of quality medical care consistent with federal, state, and regulatory standards for physician utilization review management and documentation. This position will work with Cook County Health (CCH) leadership to identify opportunities to improve care and documentation as well as minimize clinical denials by providing the physician perspective on utilization review to achieve physician adoption of best practices and documentation requirements.
The Physician Advisor will serve as a liaison between the departments engaged in revenue cycle/reimbursement, e.g. Utilization Management (UM), Health Information Management, Patient Accounts, Managed Care/County Care, as well as, Quality and Patient Safety, Risk Management, Corporate Compliance, Providers, Insurers and CCH senior leadership. The Physician Advisor will also be responsible for providing guidance and education to providers on utilization review regulatory changes as well as documentation requirements to support coding, reimbursement, quality and outcomes measurement and medical necessity for the services provided. The Physician Advisor will be required to provide direct patient care.
This position is exempt from Career Service under the CCH Personnel Rules.
Serves as a subject matter expert for physician utilization review management and documentation providing guidance and education to efficiently submit information for timely reimbursement.
Provides prospective, concurrent, and retrospective review and opinion on cases referred by utilization review, case management, and clinical documentation specialists including cases referred for medical necessity and appropriate level of care.
Supports staff in activities related to quality, utilization, and resource management.
Serves as a resource in reviewing cases and interfacing with physicians to obtain responses to coding queries.
Creates an environment that is data driven to review the utilization of resources and objectively measure the outcomes for inpatient and observation stays. Monitors physician and group patterns and presents the information to physician and hospital committees.
Reviews cases under dispute with third party payers and presents the hospital's case to third party payer Medical Director or Peer Review Board, to overturn denials and receive payment.
Identifies barriers to timely discharge and assists with developing solutions to remove those barriers in collaboration with care management and community partners.
Collaborates with hospital leadership, case management, and business office staff to assist in addressing concurrent and retrospective denials.
Provides education to medical staff and house staff on new clinical practice guidelines, protocols, research evidence and regulatory requirements including, but not limited to, ICD-10, meaningful use, Centers for Medicare & Medicaid Services (CMS), Joint Commission and compliance.
Guides physicians to adopt new or revised processes or guidelines for the improvement of quality of care, outcomes, and documentation.
Collaborates with executive and clinical leadership to develop a process for providing ongoing provider performance feedback in the areas of quality, outcomes, documentation quality, and utilization review.
Provides one-on-one provider education when necessary on a wide array of topics including quality, utilization review, and documentation improvement.
Collaborates with leadership to implement and monitor clinical initiatives and the development of clinical indicators/diagnostic criteria for diagnoses that prove problematic for reimbursement.
Collaborates with the Chief Medical Information Officer, Health Information Management, and clinical leaders to develop Electronic Medical Record (EMR) tools that optimize documentation quality and reimbursement.
Mediates and resolve conflicts with medical staff where quality, documentation, and utilization or case management are at issue.
Provides leadership for Case Management staff by directing case management teams regarding appropriateness of patient specific plans of care and discharge planning.
Collaborates with the Director of Inpatient Care Coordination, UM Committee leads and other clinical representatives to improve throughput, length of stay, readmission rates and transitions.
Facilitates strong working relationship between providers, nursing, clinical documentation specialists, case managers, utilization review staff, coding, and the management team.
Attends appropriate medical department meetings sharing information specific to department utilization performance, updating the department on internal or external utilization practices, educating physicians on statistical and other review techniques.
Participates as a team member on committees or subcommittees.
Provides supervision and oversight to utilization management professional and support staff, as needed.
Provides direct patient care as an attending physician in the area of clinical specialty.
Performs other duties as assigned.
Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school
Must be licensed as a physician in the State of Illinois or have the ability to obtain Illinois physician licensure prior to starting employment
Current and valid Illinois Controlled substance License or have the ability to obtain license prior to starting employment
Current and valid licensure with the Federal DEA or have the ability to obtain licensure prior to starting employment
Board certification in clinical area of expertise
Five (5) years of clinical practice experience in a large health care system or group practice
Three (3) years of experience using an integrated electronic medical record
Two (2) years of experience in Utilization Management, i.e. member of a UM committee
Current Health Care Quality and Management Certification (CHCQM) by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or the ability to obtain certification within six months following employment
Current Physician Advisor Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or the ability to obtain certification within one (1) year following employment
Two (2) years of experience using a large scale EMR platform (e.g. Cerner, EPIC)
Three (3) years of experience working in a multispecialty group practice
Knowledge, Skills, Abilities and Other Characteristics
Knowledge of current health care regulation, accreditation and licensure requirements for physicians and facilities.
Knowledge of Quality Management, Utilization Management, documentation processes and program structure.
Knowledge of utilization, case management, clinical documentation, and quality guidelines.
Knowledge of applicable Federal, State, and local laws and regulations, Corporate Integrity Program, Code of Ethics, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
Excellent interpersonal skills with ability to build collaborative working relationships with medical staff, clinical staff, finance, and compliance.
Excellent written and oral communication skills; ability to write clearly and succinctly in a variety of communication settings and styles.
Ability to demonstrate a comprehensive knowledge of a broad range of medical/surgical diagnoses, treatment modalities, therapeutic services, and intervention techniques.
Ability and willingness to effectively approach physicians on issues related to quality, documentation and utilization as needed.
Ability to make sound decisions based on criteria of Medicare/Medicaid, other payers and/or other utilization/reimbursement agencies regarding medical necessity and the quality, appropriateness, and efficacy of patient care.
Achieves excellence by being action oriented, decisive and follows through and aligns resources to accomplish objectives.
Demonstrated how to use effective strategies to facilitate change initiatives and overcome resistance to change.
Skill to builds cooperative relationships and alliances throughout the organization and relates to all levels and classifications of employees.
Ability to understand, incorporate, and demonstrate the mission, vision, and values of CCH in leadership behaviors, practices, and decisions.
Ability to understand complex issues and develops solutions that effectively address problems.
Ability to understands the role of emerging technology and its impact on operational effectiveness and organizational change.
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
* Medical, Dental, and Vision Coverage
* Basic Term Life Insurance
* Pension Plan
* Deferred Compensation Program
* Paid Holidays, Vacation, and Sick Time
* You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must :
* Meet the minimum qualifications for the position.
* Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, "Are you a Military Veteran?"
* Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
***Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.***
***Must successfully meet the credentialing standards established by the Cook County Health and Hospitals System to include a State of Illinois MD license and any other license, certification, or specialized training, etc. no later than two (2) weeks prior to the candidate's start date.***
*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
*CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.
COOK COUNTY HEALTH AND HOSPITAL SYSTEMS IS AN EQUAL OPPORTUNITY EMPLOYER
ABOUT COOK COUNTY HEALTH (CCH)
The Cook County Health’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCH is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCH is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, ...collaborative health plan and enhancing the patient experience.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER