Physician Advisor - Jefferson Health

Physician Advisor

Provides consultation on the level of care, utilization of resources, discharge issues and options, timeliness and appropriateness of care, payment denials, and other issues. Consults with physicians to improve the efficiency of care delivery, transitions of care, and clinical documentation.

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Reviews clinical information on patients to determine the appropriate status – 25%
• Performs Peer to Peer (P2P) reviews to attempt to overturn denials from Payors – 40%
• Writes backend appeals to overturn denials from Payor.
• Consults with Case Managers to aid in Discharge Planning.
• Consults with Providers to aid in determining appropriate level of care for patients.
• Expedites discharges to complete work-up out of hospital.
• Participates in periodic trainings, as necessary.

Competencies:

• Values differences: Recognizing the value that different perspectives and cultures bring to an organization.
• Customer focus: Building strong customer relationships and delivering customer-centric solutions.
• Manages conflicts: Handling conflict situations effectively, with a minimum of noise.
• Instills trust: Gaining the confidence and trust of others through honesty, integrity, and authenticity.
• Action orientation: Taking on new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm.
• Communicates effectively: Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.
• Collaborates: Building partnerships and working collaboratively with others to meet shared objectives.
• Interpersonal savvy: Relating openly and comfortably with diverse groups of people.
• Ensures accountability: Holding self and others accountable to meet commitments.
• Self-development: Actively seeking new ways to grow and be challenged using both formal and informal development channels.
• Optimizes work processes: Knowing the most effective and efficient processes to get things done, with a focus on continuous improvement.
• Cultivates innovation: Creating new and better ways for the organization to be successful.
• Tech savvy: Anticipating and adopting innovations in business-building digital and technology applications.
• Demonstrates self-awareness: Using a combination of feedback and reflection to gain productive insight into personal strengths and weaknesses.
• Nimble learning: Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder.
• Being resilient: Rebounding from setbacks and adversity when facing difficult situations.

Education:

• Medical Degree (MD/DO or equivalent)

Experience:

• Five (5) years Delivering direct patient care in a hospital setting

Minimum Certifications, Registration or License Requirements:

PA Medical License Upon Hire

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America