Location: Boise, Idaho
St. Luke's Health System in Boise, ID is seeking a Physician Advisor to join our team.
The Physician Advisor mediates amongst different departments, teams, or individuals involved with the patient's episode of care. The Physician Advisor aligns and drives performance improvement opportunities within the Medical Staff and Utilization Management to achieve the highest quality and regulatory compliance.
The Physician Advisor (PA) drives quality performance across the organization by communicating and coordinating with hospital leadership, physicians, utilization management, clinical documentation, denials, and quality staff to champion best practices for documentation directly related to evidence-based care.
Acute Inpatient Utilization Management (UM) Functions:* Reviews medical records of patients identified by UM or as requested by the healthcare team * Assists with level of care and length of stay management * Acts as a liaison between UM/case management and providers to collaborate on appropriate plans of care * Participates in the review of extended stay patients with UM/case management and the multidisciplinary team.* Provides guidance to ED Physicians and UM regarding issues and alternatives to acute care * Collaborates with Care Management and Hospitalist/Attending provider interdisciplinary teams to ensure appropriate continuity of care and reduce readmissions * Engages in UM committees
Collaborates with system medical leadership to educate providers on documentation that impacts quality/compliance metrics and audits.
Collaborates to coordinate and positively impact denials management functions. Reviews concurrent and retro-denials and authors appeal letters as needed. s Supports providers in peer to peers with payors. Acts as a liaison with payors to facilitate approvals and prevent denials or carved out days when appropriate.
Directs processes to meet regulatory requirements anddocumentation standards in accordance with the organization's objectives for assuring quality patient care and effective, efficient utilization of health care services.
Acts a resource for the medical staff regarding federal and state utilization and quality regulations. Acts as a consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalizations, continued stay and resource usag Other duties and responsibilities as assigned.
Education: Graduation from an accredited school of Medicine or Osteopathy and successful completion of an accredited residency program.Experience: 3 years clinical practice and demonstrated progressive leadership roles within healthcare organization(s).Licenses/Certifications: Current, unrestricted medical license in state of residence.