- Provide physician support to Care Coordinators providing Case Management and Utilization Review services.
- Review cases for medical necessity and educate and collaborate with residents, hospitalists and attendings in determining appropriate inpatient versus observation status.
- Participate in denial and appeal processes, acting as a member of the Utilization Review Committee,
- Provide assistance to Clinical Documentation Improvement Specialists
- Lead the center in the introduction of contemporary medical management practices.
- Lead a team of residents and students from our Internal Medicine Residency.
- Develop positive relationships to provide education to Hospitalist and Faculty Attendings, Medical Residents, and Community Attendings to support appropriate initial and follow-up documentation to support Medical Necessity and optimization of LOS.
- Review Medical Necessity of new Patients admitted for Observation Services (maximum of 8 patients per day). The PA will not be the assigned Attending for Observation patients for a 6-month time period.
- Lead medical providers, case management, and hospital leadership regarding hospital metrics to achieve the following improvements (to be reviewed monthly):
- Length of Stay: Decrease by X%
- Observation Hours: Decrease to 24 hours or less
- Patient Status Conversion Rate, OBS to IP: 0-2%
- Initial Clinical Denial Rate: Decrease by X%
- Overall Win Loss Ratio: Increase to 60/40
- Inpatient Win Loss Ratio: Increase to X
- Post-Discharge Win Loss Ratio: Increase to X
- Function as a resource in peer to peer reviews, denials, and appeals with commercial and governmental insurance payers.
- Chair the Utilization Review and Utilization Management Committee.
- Be a direct link to the medical staff and a liaison between the medical staff and hospital administration to increase and optimize utilization review and quality.
- MD or DO degree
- Board certified in Internal Medicine
- 10+ years experience as Internal Medicine Attending Physician in teaching hospital
- Experience as a Physician Advisor required