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Job ID: 8120
Location: Raleigh, NC
Facility/Division: UNC REX Healthcare
Status: Full Time
Shift: Day Job
Become part of a diverse and experienced team of physicians, whose mission is to support
UNC Rex Hospital and UNC Rex Physicians in areas including compliance, documentation optimization, utilization management and capacity/throughput management.
The UNC Rex Physician advisor team is searching for a dynamic, experienced physician leader who is passionate about transforming the future of healthcare. This physician leader is a visible ambassador between UNC Rex Providers and UNC Rex administration and is critical to establishing strong clinical relationships with referring physicians and hospitals through work alongside the SPLC Transfer Center. The UNC Rex Physician Advisor works closely with the UNC Rex case management department as a liaison for communication surrounding appropriate level of care and discharge planning, including complex patient discharges. This physician advisor is expected to demonstrate exceptional clinical, leadership, communication, critical thinking, organizational, and time management skills.
The ideal candidate is passionate about utilization management, innovating clinical best practice, maintaining CMS compliance and driving exceptional patient-centered care. The role requires a 0.25 to 0.50 FTE commitment to the UNC Rex Case Management Department. Reports to: UNC Rex Lead Physician Advisor and Director of Case Management
Key Functions and Responsibilities:
• Physician advisor work is broad in scope and includes two distinct roles, which will fluctuate on a day-to-day basis.
• The role of the utilization management physician advisor is primarily one of compliance and utilization review. This work includes case reviews of referred cases to determine appropriateness of patient class, inpatient vs. outpatient status. This determination will be based on utilization of approved screening criteria and clinical judgement.
• The utilization management physician advisor is also expected to participate in peer to peer discussions with medical directors from various insurance plans including Humana, UHC and Aetna.
• The role of the patient progression physician advisor includes overflow concurrent secondary utilization reviews for level of care determinations, retrospective denial management for level of care reviews and peer to peer discussions, management of post acute service denials including SNF, LTAC and AIR denial, as well as involvement in concurrent complex case reviews.
• The patient progression physician advisor is also expected to manage and facilitate Outside Hospital Transfer requests for the hospitalist team, as well as facilitation of all back transfers to originating hospitals. In this role, the on call physician advisor will be available during assigned hours to receive calls and accept appropriate patients in accordance with EMTALA guidelines. Consideration will be made to acuity of care, bed availability and clinical needs in coordination with review of the case by UNC Rex specialist physicians. Scope includes only patients appropriate for the hospitalist service.
• Both physician advisor roles will: o Promote an environment of teamwork and inter-professional collaboration to ensure an integrated team approach to patient care and capacity management. o Engage other providers, nursing and case management staff through collaborative problem solving and decision-making discussions. o Attend staff and case management meetings, and others as necessary, including utilization management committee, patient progression committee and clinical and management team meetings, etc.
o Comply with regulatory pathways and interact with applicable agencies on the local, state, and federal level o Represent medical providers on committees and participate in managing the day-to-day clinical operations and capacity management at UNC Rex Hospital
Other Information Education Requirements:
● Graduation from Medical School. Licensure/Certification Requirements: ● Board Certified/Board Eligible Physician in Internal Medicine, Family Medicine, Geriatrics, General Surgery or Emergency Medicine. Professional Experience Requirements: ● At least two years of inpatient hospital experience as a practicing physician required. ● Experience as a hospitalist or in a skilled nursing facility is preferred. Knowledge/Skills/and Abilities Requirements: ● Committed to partnering with providers, nurses and other healthcare professions to create an environment of compliance, revenue integrity and fiscal responsibility ● Possess expert, complex, clinical decision-making skills; triage and collaboration skills ● Excellent clinical and communication skills. ● Demonstrated ability to collaborate with and influence peers and other providers to drive department success. ● Effective in offering support of others and educating other providers on documentation integrity efforts and CMS compliance rules and regulations ● Demonstrated ability to work within a multidisciplinary team. Handles conflict with fairness, courtesy, diplomacy, honesty, firmness, empathy and confidence. ● Approaches problem-solving by focusing on patients first. Advocates for care that best serves the patient. ● Experience with electronic medical records as well as demonstrated comfort with technology
The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.
UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.