Job Information

Providence NorCal Physician Advisor/Medical Director, Humboldt County in Eureka, California

Description

THE ROLE

Primary accountability for the Physician Advisor is to promote high value care, efficient utilization of resources, effective patient flow, appropriate length of stay management, and optimal clinical documentation at the Medical Center by engaging with physicians, physician leadership, the Director of Care Management, and the Executive Leadership Team - particularly the CMO, CNO, and CFO. Principal responsibilities of the Physician Advisor shall be to provide clinical expertise to Care Management in the form of strategic partnership as well as in the addressing of escalations that include admission status determinations, delays in discharge, and the providing of clinical input for denial management. The Physician Advisor shall also participate in the Utilization Management Committee, and Throughput (Patient Flow) Committee where applicable, while also supporting Clinical Documentation Integrity to ensure optimal clinical documentation in the medical record. This position is intended to be a full-time administrative position and shall not replace or usurp the authority of the Chief of Staff, the Medical Staff department or Medical Staff committees as outlined in the Medical Staff Bylaws and Rules & Regulations.

ESSENTIAL FUNCTIONS

  • Support Clinical Documentation Integrity (CDI) by addressing pending queries with physicians, providing relevant physician education, sharing relevant data, and providing strategic direction for optimizing clinical documentation

  • Establishes new policies and/or procedures in conjunction with other medical center departments that are designed to improve physician access, convenience, and service levels with ultimate goal of enhancing medical center patient volume.

  • Provide support to Care Management by:

  • addressing complex patient discharges

  • assessing appropriateness of inpatient vs observation status for admitted patients

  • addressing medical necessity both clinically as well as documented by physicians in the medical record

  • assisting in appeals or denials for lack of medical necessity

  • assisting with securing authorizations from commercial payors

  • advocating for efficient LOS management during hospitalist meetings, executive meetings, and other related meetings

  • Provide physician education on clinical documentation, medical necessity, status determinations, LOS management, and Medicare rules as they relate to reimbursement and patient benefits

  • Utilize data to identify opportunities for process improvements and trend performance on medical center objectives as they relate to LOS, utilization, cost per case, clinical documentation improvement and/or other care management related goals

  • Promote a culture of high value care, stewardship of resources, and efficient patient flow by effectively engaging with physicians and other staff

  • Develop strong relationships with hospitalists, medical staff, Case Management, nursing staff, ancillary staff, and Executive Leadership to enhance alignment on key strategic goals of the medical center, Division, and System

  • Participate in SNF and LTACH Collaboratives as applicable and help to facilitate and develop strong sustainable partnerships with leaders of these and all relevant local post-acute facilities

QUALIFICATIONS

  • MD or DO (From accredited program) is preferred. Current valid license in state of CA.

  • Bachelor's degree in Public Health or Business Administration required, MBA preferred.

  • 3 years of experience as Physician Advisor, Medical Director preferred or equivalent in Medical Group Management

  • Working knowledge of utilization management and review essential to operations management and to clinical improvement

  • Understanding of the dynamics of health care industry and its effects on all stakeholders

  • Ability to develop and maintain strong, effective relationships with the medical staff, Board of Trustees, and hospital management

  • Ability to effectively communicate with, motivate, and assist medical staff leadership to adhere to utilization management, clinical documentation, and other legal/regulatory requirements

  • Ability to provide timely consultation to, and support for, the case management department regarding concurrent assessments of patient status, complex patient cases, and escalations to providers regarding discharge from the hospital.

Please note that this role will require an onsite commitment for the first 3 months with the flexibility to become remote for qualified candidates in CA.

This position will cover Humboldt County: St. Joesph Hospital Eureka (142 beds) and Redwood Memorial Hospital (critical access 25 beds).

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Northern California, Providence provides health care services to Eureka, Redwood, Petaluma, Napa and Santa Rosa.

Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 173705
Company: Providence Jobs
Job Category: Provider Network
Job Function: Health Plans Services
Job Schedule: Full time
Job Shift: Day
Career Track: Leadership
Department: 7820 URM
Address: CA Eureka 2700 Dolbeer St
Pay Range: $96.37 - $160.21
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.

Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.