Physician Advisor with Allegheny Health Network

The Allegheny Health Network (AHN) is recruiting a full-time Physician Advisor to join our teams located in Erie and Pittsburgh, PA.

Essential Responsibilities:

• The Physician Advisor works in concert with the admitting physician, Case Management, and other hospital personnel, to evaluate the medical necessity and appropriateness of: admission to the hospital, utilization of observation status and services for those patients, continued stay in the hospital, and ancillary services ordered. When appropriate, discuss the case with the attending physician regarding medical necessity.
• When requested, discuss the case with the insurance company medical director to obtain payer authorization or conduct a peer-to-peer discussion in cases of a denial.
• Provide medical expertise, advice, and support to the Case Management Department.
• Provide education to the medical staff regarding medical necessity and appropriateness of health care services.
• Provides ongoing education to residents/colleagues regarding observation status and case management.
• Assists with appeal letters and participates in data collection activities for utilization management.
• Receives daily report from Nursing Service (Bed Management) and Case Management on all observation cases.
• Reviews the status of observation cases, facilitates use of institutional processes and communicates with attending physicians and case managers regarding the patient's status.
• Conducts interdisciplinary rounds to drive quality and reduce length of stay in concert with case management, physicians, and the rest of the multidisciplinary team.
• Interacts regularly with coding and clinical documentation specialists.
• The Physician Advisor is required to be an active member of the Utilization Management Committee.
• Leads and reports data on case management and observation services on the bi-weekly Throughput Meeting.
• The Physician Advisor needs to be able to review and analyze metric reporting dashboards and implement action plans if not meeting goals.

Qualifications:

Minimum:

• Doctorate in Medicine, MD or DO
• 5 years of clinical practice experience in a hospital setting required
• Board Certified in any Medical Subspecialty
• Pennsylvania Medical License

Preferred:

• Board Certified in Quality/Physician Advising
• Physician Advisor experience in a clinical setting
• Physician Advisor experience with cross-functional teams
• Physician Advisor experience with large health system
• Physician Advisor experience with integrated payer/provider network

AHN Proudly Offers:

• Competitive Compensation Package
• Health, Dental & Vision Insurance
• Retirement Benefits
• Generous PTO Plan
• CME time and stipend
• Additional benefits include, but not limited to: EAP, Employee Discounts, and Gym Discounts

Why AHN? It’s a blended healthcare organization providing patients with exceptional healthcare for over a century. As a Blended Health organization, we are forging innovative solutions and key partnerships to help transform the health experience of our customers in remarkable ways. AHN's innovative approach ensures that patients receive top-notch care close to home, supported by 14 hospitals, over 250 healthcare facilities and 3,000+ physicians.

About Allegheny Health Network

Allegheny Health Network has received numerous national, regional and local accolades for superior outcomes, quality care, and positive impacts on the communities we serve. Comprised of 14 hospitals, 5 Health+Wellness Pavilions and more than 250 primary and specialty care practices, the AHN team includes approximately 2,400 physicians, 21,000 employees and 2,000 volunteers. Together, we provide world-class medicine to patients in our communities, across the country and around the world. Our physicians continually explore and develop new treatments that allow us to bring medical discoveries from the laboratory directly to patients. These breakthroughs help to save lives and give patients access to the latest treatments for disease and medical conditions. Allegheny Health Network is also committed to educating and training the next generation of doctors by serving as the clinical campus for both Temple University School of Medicine and Drexel University College of Medicine. We have received accolades from numerous organizations, including Thomson Reuters, AARP, Healthgrades, and Consumer Reports. These accolades recognize our dedication to excellence, but they also strengthen our ability to tackle the diseases that confront us today so that we may find a cure for tomorrow.