National Health Plan is seeking a Physician Advisor for a regional hospital campus. This is a full-time, non-clinical role that is based out of the hospital administrative offices.
The Physician Advisor provides consultation services to the assigned department consistent with the policies and standard of the hospital and the health plan.
typical roles and responsibilities for Physician Advisor
Performs duties consistent with all applicable accrediting agencies, third party payor requirements and professional ethics. Works cooperatively with the department personnel, physicians, and other personnel, prepares appropriate documentation of services provided and participates in assignments from third party payors
- Performs concurrent review of medical records for causes which fail to meet criteria for admission or continued stay.
- Exercises clinical judgment to over-ride screening criteria and approve admission or continued stay.
- Performs all duties and responsibilities required of a physician in assessing quality and cost-effective care in accordance with accepted medical standards and protocol.
- Collaborates effectively with department staff, other physicians, and other personnel consistent with professional medical standards.
- Adheres to all applicable professional, ethical, and legal standards in the performance of duties.
- Prepares timely and accurate charts and forms to document services provided as prescribed by the department.
- Completes documentation as required by third party payors.
- Participates in development, implementation, and evaluation of utilization review programs. Participates in meeting department, fiscal and operational goals.
- Maintains and enhances professional expertise through a personal development program of education/organizational activities.
Requirements for Physician Advisor
- Current licensure as a M.D. or D.O. in the State of California.
- Meets all qualifications as defined in the Medical Staff by-laws.
- Board eligible or certified in Internal Medicine by the American Board of Internal Medicine or Family Medicine by the American Board of Family Practice.
- Board certification preferred.
- Two years of experience in a physician leadership role.
- Previous experience working in a hospital setting
- Interpersonal skills to communicate and coordinate effectively with physicians, administration, nursing staff and other ancillary and professional staff.
- Clinical expertise to care for patients with a variety of medical conditions.