Description
Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference.
Job Summary
The Lead Physician Advisor provides leadership for efficiently managing resource and utilization to deliver quality cost- effective care in the most appropriate setting. Works closely with the medical staff leadership, the entire medical staff, including resident physician house staff in all areas of resource/utilization management to develop and implement methods to optimize use of hospital services for all patients.
This includes working with hospital leadership in developing care management protocols with physicians and others to optimize efficient management of resources, insuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, performing Peer to Peer reviews, Short Stay Reviews, Extended Observation. Provides for medical staff education and training as required. Provides periodic reports to Board, MEC and Joint Conference as deemed necessary.
Roles and Responsibilities
- Maintains accountability for achieving utilization / resource management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care.
- Reviews issues identified by UR staff to ensure appropriate follow-up, recommend improvement initiatives as needed, and make referrals to the appropriate department chair as necessary.
- Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Utilization department in a timely fashion.
- Provides consultation to nurses and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management.
- Provides for development and dissemination of required protocols, policy and procedures to support revenue cycle goals and compliance with regulations.
- Participate in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested.
- Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable.
- Facilitates local system utilization management training and education to Boards, MEC and medical staff departments as required.
- Provides for coordination and improvement in QIO audits.
- Develops statistical reports related to revenue improvement and denial reduction within scope and as requested by Local System Boards, MEC and other local system committees.
- Work with Human Resources on orientation, orientation handbook, compliance, scheduling, training, client engagement, quality and dashboards.
- Collaborate with other departments, attend company meetings and coordinate and provide updates on new processes, policies and procedures.
- Deliver bi-monthly and yearly evaluations.
- Lead weekly, quarterly meetings and develop webinar presentations.
- Grow Physician Advisory program through speaking at conferences, webcasts and podcasts.
- Collaborate with payors to establish strategies to work together.
