Physician Advisor - Full-time / Part-time

Physician Advisor

At the Cleveland Clinic we strive to provide the best possible patient care. Each of our hospitals must also ensure that it maintains the fiscal discipline necessary to ensure its long-term viability. The Physician Advisor is the liaison between Revenue Cycle Management, Utilization Management and Physician practice. The Physician Advisors function as a clinical resource and consultant to medical staff and the Case Managers by providing identification, facilitation and resolution to utilization management issues.

Job Description

Responsibilities:

* Utilizes clinical guidelines and promotes standardization of clinical practice through best practice implementation.

* Supports and promotes care plan development and documentation compliance.

* Conducts concurrent second-level medical necessity reviews for all patient cases that do not meet first-level screening criteria for an inpatient admission.

* All factors mandated by CMS must be considered during this review, including: the patient's medical history and current medical needs.

* Coordinates the process and documentation of proper Medicare Condition Code 44 use, when appropriate and assists with effective management of length of stay.

* Facilitates communication between managed care organizations and the hospital regarding benefit coverage issues, utilization review and quality assurance processes.

* Facilitates and assists the Pre-Access team with peer to peer reviews to obtain authorization for surgical cases.

* Performs retrospective clinical reviews utilizing payer policies, Government policies and clinical research to appeal denials.

* Communicates with commercial payers as requested to resolve any disputes surrounding medical necessity and authorization appeal determinations.

* Documents clearly and concisely all interactions, interventions and outcomes of clinical reviews in the Care Management tool and/or hospital billing systems.

* Provides consultation to Case Managers regarding complex clinical issues and advises on next steps.

* Serves as a consultant to medical professionals providing peer education to decrease denials and ensure compliance with regulatory requirements.

* Provides educational sessions including but not limited to patient status, appropriate documentation, payer requirements and government regulations.

* Participates on hospital committee's and provides feedback on denial trends, practice patterns and recommendations for process improvement.

* Serving as an expert advisor to the hospital's UR Committee.

* Keeps up to date on the latest technologies and medical procedures.

* Other duties as assigned.

Education:

* Medical Doctor degree required.

Certifications:

* Doctor of Medicine (MD) or Doctor of Osteopathy (DO) required.

* Board certified required.

Complexity of Work:

* Requires critical think skills, decisive judgment and the ability to work with minimal supervision.

* Must be able to work in stressful environment and take appropriate action.

Work Experience:

* Minimum of 3 years recent clinical experience.

* Background or actual involvement in health service delivery research or decision analysis preferred.

* Utilization Management or past Physician Advisor experience preferred.

* Knowledge of clinical criteria-Milliman and InterQual preferred.

Physical Requirements:

* Manual dexterity to operate office equipment.

* Requires extended periods of standing, walking, sitting and carrying up to 25 pounds.

* Normal or corrected vision and hearing to normal range.

Personal Protective Equipment:

* Follows Standard Precautions using personal protective equipment as required for procedures

About Us

Cleveland Clinic is one of the world's largest and busiest health centers. Patients come to Cleveland Clinic from all over the world. We offer advanced treatment for all illnesses and disorders of the body. We enjoy a strong reputation for outstanding quality care. U.S News & World Report has declared that we are the number two hospital in the country. In cardiology and cardiac surgery, we lead the nation.

Cleveland Clinic's heart program has ranked No. 1 in the nation since 1995. Our urology program also ranked No. 1 in the nation, and three of our specialties - gastroentrerology and GI surgery, kidney disorders, and rheumatology - are ranked No. 2.

Eight other Cleveland Clinic specialties are ranked in the Top 10. Cleveland Clinic earned the highest ranking of any Ohio hospital.

Other specialties noted for national excellence include cancer and psychiatry. Cleveland Clinic Children's offers highly specialized pediatric care in a family-centered atmosphere. It has been ranked the best children's hospital in Ohio by Child magazine.

Cleveland Clinic was founded in 1921 as a not-for-profit group practice, integrating clinical and hospital care with research and physician education. In addition to our Cleveland location, we have Cleveland Clinic Florida, with a unified medical campus in Weston, Florida, offering the full spectrum of care.

Cleveland Clinic has more than 3,500 salaried physicians on staff, representing approximately 120 specialties and subspecialties. In 2016, they provided a total of 7.14 million visits. Patients came to us from across America and from more than 180 nations. We also lead an extensive system of community hospitals in Cleveland called the Cleveland Clinic Hospitals.

This system is made up of Cleveland Clinic and Fairview Hospital, Lutheran Hospital, Marymount Hospital, Euclid Hospital, Hillcrest Hospital, Medina Hospital, South Pointe Hospital, Akron General Hospital, and Avon Hospital. With 4,450 staffed beds, Cleveland Clinic Hospitals offers broad geographic coverage, a full continuum of care, improved quality and lower cost of care to Northeast Ohio residents.

Any application submitted without a CV will delay the review process

Please be advised that all information entered in your application will only be shared with Cleveland Clinic and will not be distributed to third parties.

The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic's Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility.

Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities