Saint Agnes Medical Center (SAMC) has an excellent full-time employment opportunity for a Board Certified Physician Advisor to join the Executive Management team located in Fresno, California.
Reporting to the Chief Medical Officer, the Physician Advisor (PA) will work with the CMO and other physician leaders to bring a multi-disciplinary approach to improving patient throughput. The PA will support throughput management and serve as the principal advocate for support and education regarding all aspects of the throughput process including the admission and discharge process and transitions between levels of care. The incumbent will work with medical staff leadership, the attending medical staff, and the functional areas of case management, social work, discharge planning, and utilization and resource management to develop and implement methods to optimize use of hospital services for all patients while also ensuring the value of care provided.
Responsibilities for this opportunity include:
Work with medical staff and case management to review all inpatient and selected outpatient services for medical necessity, sound medical judgement, and payer regulations. Uses evidence based care with own clinical knowledge and expertise for the basis of medical management judgments and decisions. In absence of own clinical expertise seek the input of other qualified resources.
Effectively support the medical staff in the clinical progression of patient care. Collaborate with all members of the interdisciplinary team to ensure optimal patient outcomes.
Manage/resolve issues identified by case managers to ensure appropriate follow-up, recommend improvement initiatives as needed, and make referrals to the appropriate department chair as necessary.
Comply with payer required decision-making timeframes. Respond to requests for assistance/ intervention within agreed to timeframes. Participate in developing and maintaining positive relationships with third-party payers. Ensure payer practices are followed according to policy and contracts. Hold payers accountable. Provide input into payer contracting.
Provide consultation to case management staff and the interdisciplinary care team regarding complex clinical issues and advise on next steps.
Conduct second level status determinations and medical necessity reviews as requested by case managers meeting required timeframes.
Contribute to retrospective clinical denials management process to reduce denials. Participate in clinical appeals as defined by the hospital's policy/procedures.
Study "outliers" and employs strategies/tactics to reduce the incidence and reports to the Utilization Review Committee.
As referred by the Case Management staff, intervene to remove or reduce the impact of avoidable delays on patient outcomes.
Contact physicians to resolve delays and achieve positive outcomes.
Lead the long stay discharge team to assist in decreasing length of stay for long stay patients.
Engage physician to physician communication.
Conduct physician education sessions to share data, trends, practice patterns and other relevant information. Provide ongoing education on capacity management, utilization review and resources to physicians on a regular basis. Work with physicians individually and in groups. Report practice pattern trends to the medical staff and the chairs of the department of medicine, family practice and surgery as applicable.
Advise Medical Staff leadership on appropriate policy/standard of care changes needed to achieve optimal throughput.
Chair the hospital Utilization Review Committee.
Conduct rounds to monitor compliance with developed policies and procedures for bed placement and accurate reporting of bed status.
Participate as needed in day to day bed management issues and participate in Readmission root cause analysis and performance improvement projects.
Oversight of Code 44 determinations.
Assist CMO as requested.
Documentation Improvement: Provide support within the medical community to enhance the process of obtaining the most accurate and complete documentation as well as appropriate patient status in the medical record. Lead ongoing education to the Medical Staff.
Perform other duties as assigned.
The qualified candidate will have the following education, certifications, and experience:
Doctor of Medicine degree or Doctor of Osteopathic Medicine degree is required.
License in the state of California as a physician is required.
Board Certification in a Medical Specialty is required.
At least five (5) years of medical practice is required.
Membership of Saint Agnes Medical Center's Medical Staff is required.
Appropriate training and/or experience in Utilization Review and Physician Advisory is required.
Excellent interpersonal and communication skills and the ability to work effectively with diverse personalities, ranging from practicing clinical professionals to IT personnel, operations leaders and staff are required.
Experience with large-scale project management and training is preferred.
This is an exciting opportunity for the right Administrative physician to join Saint Agnes Medical Center.
An excellent compensation and full benefits package are available for the right physician.
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. We serve people and communities in 22 states from coast to coast with more than 90 hospitals and 100 continuing care facilities – including home care, hospice, PACE and senior living facilities and programs that provide nearly two and a half million visits annually. Trinity Health employs more than 133,000 colleagues, including 7,800 employed physicians and clinicians.
Our mission: We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities. We support this mission by living our core values of Reverence, Commitment to Those Who are Poor, Justice, Stewardship, and Integrity. Committed to recruiting talented physicians, we are looking for physicians who share our values and want to help us fulfill the health care needs of the communities we serve.
At Trinity Health, we value the physician relationship and focus on partnering with our physicians. Whether you are a practicing physician looking to relocate or a medical resident, we offer opportunities with the flexibility to fit your indivi...dual needs. If you would like to be part of Trinity Health, we encourage you to explore this opportunity at www.trinity-health.org