Summary

POSITION SUMMARY:   **Must be a board certified medical doctor (M.D.)   This position is part-time / 10 hours per week.    The Physician Advisor, in partnership with Care Management leadership, acts as a champion of high quality admissions and all transitions of care across the continuum at Sinai Hospital. The Physician Advisor acts as an advisor, educator and administrative support to Care Management and the Care Transitions Program. The Advisor also serves as a liaison between these programs, the hospital's medical leadership and physician staff. The advisor communicates and provides data to physicians, care managers, nurses and other clinical staff related to the efficient and effective utilization of clinical resources. The advisor serves as a liaison to third party payers concerning matters related to utilization review, care coordination and transitions of care planning.   Essential Functions:   Advisory Duties: Services as clinical resource to the department of Care Management. Provides clinical knowledge and expertise to guide care management assessment, planning and interventions. Serves as an advisor to hospital administration, the Medical Executive Committee and ad hoc committees concerning payer, quality or utilization issues. Collaborates with Care Management, administrative and medical staff leadership and the clinical healthcare team to develop strategies to manage avoidable readmissions. Actively involved in hospital-wide quality improvement initiatives.   Administrative Duties: Conducts administrative duties to support effective care management of patients. Conducts concurrent chart reviews of electronic and paper records to determine appropriate utilization and treatment plan for cases identified as delays and for long-stay complex medical cases. Identifies trends that lead to increased denied days or extended lengths of stay. Attends regular and ad-hoc meetings with Care Management and Medical staff leadership to review trends in physician practice. Assist in the development of strategies for intervention and improvement. Meets on a regular basis with Care Management leadership to strategize and prioritize program and organizational needs. In collaboration with the Director of Care Management, sets the agenda for Utilization Management and/or Denials Management Committees.   Educational Duties: Educates medical staff on evidence-based best practices, appropriate utilization of clinical resources and alternative levels of patient care. Rounds on patient care units to address clinical management issues. Educates the interdisciplinary team and providers. Supports medical staff leadership in driving evidence-based medicine and other organization-wide physician initiatives.   Medical Liaison: Facilitates collaboration between care managers and medical staff. Utilizes interpersonal skills to communicate with physicians, clinical and interdisciplinary staff regarding treatment plans, optimal care and high-quality discharges. Intervenes to remove barriers to optimal care and shares trends with Care Management and medical staff leadership.   Liaison to Payers: Develops and maintains collaborative relationships with third party payers. Communicates with health plan medical directors regarding denials, medical necessity and expedited appeals. Assists in the management of government appeals for inappropriate denials including hospital representation during administrative law judge hearings.   QUALIFICATIONS AND REQUIREMENTS: Seasoned professional knowledge; equivalent to a Master's degree; knowledge in more than one discipline. Doctor of Medicine (M.D.); MD Internal Medicine; Board certification Excellent communication and leadership skills; advanced knowledge of medical necessity reviews, Milliman and Interqual criteria, and health care reimbursement regulation. 5-7 years of relevant experience.

Additional Information

As one of the largest health care providers in Maryland, with 13,000 team members, We strive to CARE BRAVELY for over 1 million patients annually. LifeBridge Health includes Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center, as well as our Community Physician Enterprise, Center for Hope, Practice Dynamics, and business partners: LifeBridge Health & Fitness, ExpressCare and HomeCare of Maryland.