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Job Title: Physician Advisor

Company: Good Samaritan Hospital

City/State: Suffern, NY

Category: Physicians

Department: Care Management

Position: Full Time

Hours: M-F 9-5pm

Shift: Days

Req #: 2042

Job Details:

Physician Advisor

 

To serve as a liaison with providers, case managers, hospital leadership and payers on utilization management and revenue integrity. Provide education to ensure physician documentation appropriately supports the actual care provided.



Responsibilities and Scope of Work:

 

Concurrent/Pro-Active:

 

  • Provide secondary reviews for appropriate patient status and level of care and discuss with the attending as appropriate.
  • Resolve concurrent patient status and level of care disputes with payors and physicians.
  • Provide education to physicians and case managers on denial and payor trends, MCG and admission criteria, documentation, and CMS/other regulatory requirements and updates.

Other:

  • Review payor denials and assist in the appeals process as necessary including attending hearings.
  • Review CDI queries for completeness and accuracy, consult with physicians to ensure accurate and timely responses.
  • Assist case management in assessing regulatory compliance.
  • Assist case management in reviewing one day stays and provide feedback to physicians.
  • Support the hospitals by attending length of stay rounds/meetings, case management meetings and utilization management committee meetings, as available/requested.

 

Qualifications:

 

  • Maintains a medical license from the state of NY.
  • A member of the American College of Physician Advisors
  • Previous utilization management, case management or peer review documentation experience in hospitals or health plans.
  • In clinical practice within the past five years.
  • Has the ability to travel among the WMC HEALTH NETWORK hospitals on a regular basis. 
  • Internal Medicine background
  • Experience as a CDI champion and/or Case management Physician Advisor or having 3-5 years as a Physician Reviewer/Advisor with a third party leveling and/or appeals agency
  • Knowledge of MCG Guidelines preferred
  • Experience with Allscripts/Cerner preferred

About Us:

Good Samaritan Hospital

Good Samaritan Hospital in Suffern, NY, is a 286-bed hospital providing emergency, medical, surgical, obstetrical/gynecological and acute-care services to residents of Rockland and southern Orange counties in New York; and northern Bergen County, NJ. The hospital is home to a recognized cardiovascular program, comprehensive cancer-treatment services, the area’s leading Wound and Hyperbaric Institute and outstanding maternal/child services that includes a Children’s Diagnostic Center. Good Samaritan Hospital also provides social, psychiatric and substance-abuse services and its certified home-care agency supports residents of the Hudson Valley and beyond.