Physician Advisor Medical Director, Rochester Regional Health

Within our Physician Advisor Program and serving as Medical Director, management is responsible for providing leadership oversight to Rochester Regional Health’s Physician Advisor Program and its continued expansion across the healthcare system by providing overall guidance and direction to the appropriate stakeholders.  This physician leader is responsible for the implementation of a strategic plan for physician collaboration with the Utilization Management Program, including level of care (LOC) determination, coding and documentation improvement (CDI), and denial & appeal (D&A) management by providing overall guidance and oversight to the appropriate stakeholders. This individual shall lead a team of Physician Advisors who will participate in the above activities on a case-by-case level, support the CDI, LOC, and D&A teams, and engage the medical staff in participating in these processes through UMD-Liaisons. This individual will assist the Vice president of Health Informatics, CMIO, and CMO in achieving other goals like compliance, audit management, clinical efficiency, and systems integration as needed. Additionally, this individual serves as a subject-matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient-focused and cost-effective medical care.

Key Responsibilities           

• Participate in PAd activities on a case-by-case level, support LOC, CDI, appeal, or compliance decisions (perform tasks described in Associate PAd and PAd job description) as necessary
 
• Oversee the interactions between the PAd program with UMD teams and provider teams (via UMD-Liaison): on group-to-group and person-to-person levels
 
• Hire and train PAd-s as necessary
 
• Develop educational programs regarding LOC, CDI, D&A, compliance issues for Physician Advisors, and education and engagement campaigns for the medical staff
 
• Act as subject matter expert in complex utilization review and management decisions
 
• Act as subject matter expert in Medicare DNB reviews and Sepsis audits
 
• Develop a maintenance and QI program for the PAd-s (education, team building, performance reviews)
 
• Engagement and dispute resolution with payors (MVP, UHC, etc.) at the executive leadership level
 
• Engage with external entities like HANYS, Change Healthcare (Interqual), DFS, ESMSEF, IPRO, etc.,
 
• Integrating advanced technology solutions into current utilization review and management workflows
 
• Serve as a back-up for Medical DirectorPhysician Advisor Program – Strategy and Planning as needed
 
• Other duties as assigned

Desired Attributes:             

• Board certification in HCQM (ABQAURP)
 
• Master’s degree in business or healthcare administration
 
• 2 years of progressive program/project development and quality improvement experience
 
• High level of organizational & analytical skills to manage projects, timetables, and implementations
 
• High level of collaboration, team building, and inter-disciplinary skills needed to accomplish complex activities
 
• Advanced interpersonal skills to develop effective teams and manage, direct and coordinate tam activities
 
• Ability to influence, negotiate and motivate collaborators
 
• Strong analytical skills
 
• Able to develop meaningful metrics, data collection, and analysis
 
• Keen understanding of the PDSA cycle implementation
 
• Must be able to positively communicate and work with professionals at all levels of the organization

Minimum Qualifications

• Physician, M.D. or D.O.
 
• 3 years of Physician Advisor experience
 
• 2 years of clinical/organizational leadership experience
 
• Required licensure and certification skills:                      
  • Licensed in NYS and practicing clinical medicine at least 20% of the time
  • Board certification in a clinical specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association. Must have been in good standing if board certification was not renewed.

Rochester Regional Health is an integrated health services organization serving the people of Western New York, the Finger Lakes and beyond. The system provides care from 150 locations, including five hospitals, more than 100 primary and specialty practices, rehabilitation centers and ambulatory campuses, innovative senior services, facilities and independent housing, a wide range of behavioral health services, and ACM Medical Laboratory, a global leader in patient and clinical trials. 

Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran

The Rochester area feature excellent public and private schools, and a variety of housing options.  As the third-largest city in New York State, Rochester offers diverse cultural including the Rochester Philharmonic Orchestra, GeVa Theater Center, Rochester International Jazz Festival, as well as easy access to Manhattan, Boston, Washington, DC and Philadelphia.  The area also offers recreational opportunities year-round with the Finger Lakes, the Adirondacks, and surrounding ski-resorts and state parks.  Greater Rochester also boasts a thriving food, brewery, and winery culture, exceptional college and universities and is one of the top golf destinations in America.