Holy Cross Health is seeking a full-time Lead Physician Advisor located in Silver Spring, Maryland.
What We Offer:
General Summary:
Provides physician leadership and expertise related to appropriate utilization/level of care (LOC), length of stay (LOS) management, patient flow/throughput management, appropriate clinical documentation and CDI. Provides oversight for other Physician Advisors. Engages physicians in care coordination, care progression, care consistency and CDI activities. Reviews and provides physician perspective for policies that related to care coordination, patient access, CDI. Collaborates with appropriate departments, leaders and committees to meet established goals for physician participation and compliance with expectations. The employee supports the Mission of Trinity Health and Holy Cross Hospital.
Essential Functions:
Provides physician leadership for physician advisors and physicians throughout the organization. Manages processes, policies, workflows and overall management of the physician advisor role within the organization. Works to lead standardization of policy, procedure and approach to physician advisor roles in utilization management, length of stay, denials/downgrades.
Serves as physician expert and provides support to care team and care coordination staff regarding utilization decisions including screening for appropriateness of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource utilization/management, denial management issues, discharge planning (DP) advise and quality issues. Functions as a consultant and resource to other Physician Advisors and primary (attending) physicians.
Supports care team to ensure appropriate patient placement, care/discharge/etc. Ensures medical staff have understanding and compliance with applicable areas of expertise.
Provides instructional input and education to medical staff and CDI staff. Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation.
Conducts verbal and written Peer to Peer reviews to assist with appeals of denied or downgraded coverage determinations by managed care, commercial payers, and recovery audit contractors
Minimum Education/Training Required:
Experience:
Knowledge, Skills and Abilities:
Pay Range: $249,426.00-$374,140.00
Pay is based on experience, skills and education.Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates.The pay range may also vary within the stated range based on location.Holy Cross Health is an Equal Employment Opportunity (EEO) employer. Qualified applicants are considered for employment without regard toMinority/Females/disabled/Veteran (M/F/D/V) status.
About us:
Holy Cross Health is a Catholic, not-for-profit health system that serves more than 240,000 individuals each year from Maryland's two largest counties Montgomery and Prince George's counties. Holy Cross Health earns numerous national awards, clinical designations and accreditations across a wide range of specialties for providing innovative, high-quality health care services. We were named one of Americas 100 Best Hospitals for 2021.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
Note:
Bargaining unit employees are governed by the terms and conditions of their respective collective bargaining agreements, which supersede the Employment-At-Will Statement.