Physician Advisor - Part Time - Penn Presbyterian

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
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Penn Presbyterian Medical Center (PPMC) has an outstanding opportunity for an experienced Physician to join the leadership team as a Physician Advisor. This is a Part Time position with a flexible schedule (20 hours per week); position is mostly remote, but candidates need to be located within commuting distance of Philadelphia for occasional onsite meetings at PPMC. Additionally, based on candidate interest and clinical background, the option for PRN clinical work (onsite) may be available if desired.
Under the direction of the Chief Medical Officer, the Physician Advisor is a physician serving the hospital through teaching, consulting and advising, collaborating closely with medical staff leadership, medical staff, and all areas of resource management, case management, social services, discharge planning and utilization management to develop and implement methods to optimize use of hospital services. In this key leadership role, you will share expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations and appropriate physician documentation requirements. Your recommendations and guidance will have direct impact on the financial health of PPMC.
Responsibilities:
• Make recommendations on level of care including initial level of care, secondary review and as requested by case management.
• Review for daily level of care recommendations on cases placed in Observation.
• Participate in the denials management process and be a leader in optimizing denial management.
• Perform peer to peer appeals and draft appeal letters for third party denials as appropriate.
• Apply the 2-midnight rule to Medicare reviews and maintain compliance with Medicare rules as it applies to level of care recommendations.
• Stay current on changes in payer rules including CMS rules as it pertains to utilization review.
• Recommend and request additional and more complete medical record documentation from providers to support placement status or medical necessity.
• Understand and use InterQual and/or other appropriate criteria.
• Apply medical expertise to assist with appropriate billing for services.
• Provide feedback to Contracting on payer denial patterns where appropriate.
• Facilitate, mentor and educate physicians regarding documentation and payer requirements.
• Facilitate, mentor and educate case management on the utilization review process.
• Chair and/or assist the Lead Physician Advisor in chairing the Utilization Committee.
Credentials:

• Doctor Osteopathic Medicine (Required)
• Medical Doctor (Required)

Education or Equivalent Experience:

• Education Specialization: MD or DO Equivalent Experience
• Minimum 5+ years clinical experience in a hospital setting
• Solid foundation in the areas of utilization management and hospital operations
• Possess and maintain an unrestricted medical license in the State of Pennsylvania

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.