Wellstar Health System
Executive Director, MD Physician Advisor PRN
Wellstar Health System - Marietta, Georgia, United States, 30064
Work at Wellstar Health System
Overview
- View job
Overview
Join to apply for the
Executive Director, MD Physician Advisor PRN
role at
Wellstar Health System 6 days ago Be among the first 25 applicants Join to apply for the
Executive Director, MD Physician Advisor PRN
role at
Wellstar Health System Direct message the job poster from Wellstar Health System Executive Talent Sourcer at Wellstar Health System
How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
Job Summary The
Executive Director, MD Physician Advisor
reports to and is accountable to the Lead Executive Director of Physician Advisor, who reports to the Vice President Medical Outcomes. This role has similar duties to the Executive Director of Physician Advisor, as well as Denials Medical Director to impact utilization management and retrospective denials, but will not have any expanded quality improvement roles.
Utilization Management: The PRN Physician Advisor (PA) will conduct clinical review cases sent for review for commercial payers, governmental, and medicare advantage plans that are referred by Care Coordination/Case Management staff and/or other health care professionals to assess for appropriateness of care; proper level of care in accordance with hospital objectives for assuring quality patient care and effective, efficient utilization of health care services, and to meet regulatory requirements. Working as a peer to physicians and as a consultant to Care Management and administration, the PA intervenes when practice patterns or behaviors or documentation issues create disparity between pathway standards, intensity of service, severity of illness, patient and family rights, teamwork, or other issues regarding the stewardship of resources for individual patients, diagnostic populations, and the organization as a whole.
Core Responsibilities And Essential Functions The PRN Physician Advisor (PA) will work closely with Utilization management team to provide timely consultation and clinical expertise to ensure fiscally responsible and efficient utilization of resources. These duties will include but not be limited to areas such as concurrent assessment of the clinical situation, determination of medical necessity and appropriate level of care, real time feedback to physicians and case managers and all necessary follow-up with appropriate and clear communications of next actions to physicians; care coordinators, social workers, nursing staff and other key people involved in caring for individual patients whose cases have been referred for consultation:
Assist with level of care and length of stay management. This will include assessment of Inpatient vs. Outpatient Obs. Status; Compliance with 2 MN Rule, assistance with throughput initiatives and care transition issues. Assist with denial management process on a concurrent basis or retrospective basis. Work closely with the Utilization Management to expedite case management issues and manage work queues. Review and make suggestions regarding resource and service management. Assist staff with clinical review of patients. Review clinical records for appropriate and accurate clinical documentation to ensure that medical necessity and level of care for services will be substantiated. Will work with the Clinical Documentation Excellence Specialists (i.e., CDS/CDI) to assist with physician queries for documentation or clinical criterion clarification. May be involved in development and planning of care for specialized patient populations or those requiring Complex Disease & Care management. Plan and develop any programs necessary to help facilitate the management of patient populations through the continuum of care. Determine if professionally recognized standards of quality care are met by working with the Quality Department and available resources with appropriate referral to the Peer Review process if necessary. Assist in review of any reports from regulatory agencies, i.e., RAC audits, QIO reports, etc. to help determine trends, develop replies to inquiries and action plans for improvement. As part of his/her duties, the Physician Advisor will participate off-hour schedule to support the UM team on weekends and holidays. The PRN PA will be tasked to cover any Wellstar facility during normal business hours for vacations, unexpected absences or if case volumes at one or more facilities require additional help in managing the workload. Performs other duties as assigned
Complies with all Wellstar Health System policies, standards of work, and code of conduct.
Required Minimum Education Doctorate Medicine or Doctorate Osteopathic Medicine Required Minimum License(s) And Certification(s) All certifications are required upon hire unless otherwise stated. Doctor of Osteopathic Medicine or Medical Doctor Additional License(s) And Certification(s) Active MD/DO license with the State of Georgia with no restrictions. Required educational materials and training shall be completed as assigned by the supervisor. Upon Hire Required
Required Minimum Experience Minimum 3 years of clinical experience Required and Some exposure to Utilization Management with a focus on clinical documentation, medical necessity assessment, billing and utilization review committee or similar. Required
Required Minimum Skills The PRN Physician Advisor must be able to communicate and understand verbal and written English language and display a positive attitude (see WellStars Credo). Organizational skills that enable the individual to react and perform under stress and emergency situations and to manage two to three activities at one time on an ongoing basis. Must display the character and disposition to foster physician engagement. Time management skills to meet operational deadlines. Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more. Seniority level
Mid-Senior level Employment type
Full-time Job function
Business Development and Sales Industries Hospitals and Health Care Referrals increase your chances of interviewing at Wellstar Health System by 2x Get notified about new Executive Managing Director jobs in
Marietta, GA . Marietta, GA $55,000.00-$65,000.00 3 weeks ago Atlanta, GA $50,000.00-$200,000.00 6 days ago Senior Vice President / General Manager, Operating Unit Lead - Professional Services
Atlanta, GA $370,000.00-$461,000.00 5 days ago Assistant General Manager - $50,000 Salary
General Manager, Health & Life Sciences Staffing
Chief Executive Officer Minded - Acquire a Book of Business
Tucker, GA $90,000.00-$120,000.00 2 weeks ago Atlanta, GA $95,000.00-$105,000.00 1 month ago Atlanta Metropolitan Area $120,000.00-$130,000.00 3 hours ago Airline General Manager in Atlanta, GA (ATL)
Alpharetta, GA $45,000.00-$65,000.00 1 month ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr
Executive Director, MD Physician Advisor PRN
role at
Wellstar Health System 6 days ago Be among the first 25 applicants Join to apply for the
Executive Director, MD Physician Advisor PRN
role at
Wellstar Health System Direct message the job poster from Wellstar Health System Executive Talent Sourcer at Wellstar Health System
How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
Job Summary The
Executive Director, MD Physician Advisor
reports to and is accountable to the Lead Executive Director of Physician Advisor, who reports to the Vice President Medical Outcomes. This role has similar duties to the Executive Director of Physician Advisor, as well as Denials Medical Director to impact utilization management and retrospective denials, but will not have any expanded quality improvement roles.
Utilization Management: The PRN Physician Advisor (PA) will conduct clinical review cases sent for review for commercial payers, governmental, and medicare advantage plans that are referred by Care Coordination/Case Management staff and/or other health care professionals to assess for appropriateness of care; proper level of care in accordance with hospital objectives for assuring quality patient care and effective, efficient utilization of health care services, and to meet regulatory requirements. Working as a peer to physicians and as a consultant to Care Management and administration, the PA intervenes when practice patterns or behaviors or documentation issues create disparity between pathway standards, intensity of service, severity of illness, patient and family rights, teamwork, or other issues regarding the stewardship of resources for individual patients, diagnostic populations, and the organization as a whole.
Core Responsibilities And Essential Functions The PRN Physician Advisor (PA) will work closely with Utilization management team to provide timely consultation and clinical expertise to ensure fiscally responsible and efficient utilization of resources. These duties will include but not be limited to areas such as concurrent assessment of the clinical situation, determination of medical necessity and appropriate level of care, real time feedback to physicians and case managers and all necessary follow-up with appropriate and clear communications of next actions to physicians; care coordinators, social workers, nursing staff and other key people involved in caring for individual patients whose cases have been referred for consultation:
Assist with level of care and length of stay management. This will include assessment of Inpatient vs. Outpatient Obs. Status; Compliance with 2 MN Rule, assistance with throughput initiatives and care transition issues. Assist with denial management process on a concurrent basis or retrospective basis. Work closely with the Utilization Management to expedite case management issues and manage work queues. Review and make suggestions regarding resource and service management. Assist staff with clinical review of patients. Review clinical records for appropriate and accurate clinical documentation to ensure that medical necessity and level of care for services will be substantiated. Will work with the Clinical Documentation Excellence Specialists (i.e., CDS/CDI) to assist with physician queries for documentation or clinical criterion clarification. May be involved in development and planning of care for specialized patient populations or those requiring Complex Disease & Care management. Plan and develop any programs necessary to help facilitate the management of patient populations through the continuum of care. Determine if professionally recognized standards of quality care are met by working with the Quality Department and available resources with appropriate referral to the Peer Review process if necessary. Assist in review of any reports from regulatory agencies, i.e., RAC audits, QIO reports, etc. to help determine trends, develop replies to inquiries and action plans for improvement. As part of his/her duties, the Physician Advisor will participate off-hour schedule to support the UM team on weekends and holidays. The PRN PA will be tasked to cover any Wellstar facility during normal business hours for vacations, unexpected absences or if case volumes at one or more facilities require additional help in managing the workload. Performs other duties as assigned
Complies with all Wellstar Health System policies, standards of work, and code of conduct.
Required Minimum Education Doctorate Medicine or Doctorate Osteopathic Medicine Required Minimum License(s) And Certification(s) All certifications are required upon hire unless otherwise stated. Doctor of Osteopathic Medicine or Medical Doctor Additional License(s) And Certification(s) Active MD/DO license with the State of Georgia with no restrictions. Required educational materials and training shall be completed as assigned by the supervisor. Upon Hire Required
Required Minimum Experience Minimum 3 years of clinical experience Required and Some exposure to Utilization Management with a focus on clinical documentation, medical necessity assessment, billing and utilization review committee or similar. Required
Required Minimum Skills The PRN Physician Advisor must be able to communicate and understand verbal and written English language and display a positive attitude (see WellStars Credo). Organizational skills that enable the individual to react and perform under stress and emergency situations and to manage two to three activities at one time on an ongoing basis. Must display the character and disposition to foster physician engagement. Time management skills to meet operational deadlines. Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more. Seniority level
Mid-Senior level Employment type
Full-time Job function
Business Development and Sales Industries Hospitals and Health Care Referrals increase your chances of interviewing at Wellstar Health System by 2x Get notified about new Executive Managing Director jobs in
Marietta, GA . Marietta, GA $55,000.00-$65,000.00 3 weeks ago Atlanta, GA $50,000.00-$200,000.00 6 days ago Senior Vice President / General Manager, Operating Unit Lead - Professional Services
Atlanta, GA $370,000.00-$461,000.00 5 days ago Assistant General Manager - $50,000 Salary
General Manager, Health & Life Sciences Staffing
Chief Executive Officer Minded - Acquire a Book of Business
Tucker, GA $90,000.00-$120,000.00 2 weeks ago Atlanta, GA $95,000.00-$105,000.00 1 month ago Atlanta Metropolitan Area $120,000.00-$130,000.00 3 hours ago Airline General Manager in Atlanta, GA (ATL)
Alpharetta, GA $45,000.00-$65,000.00 1 month ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr