Martin Luther King, Jr. Community Hospital - Los Angeles, CA
posted 16 days ago
About the position
The Utilization Management Physician Advisory (PA) is a physician with a broad base of clinical experiences who acts as a liaison between the hospital administration, clinical staff, and support personnel. The PA position has part-time inpatient responsibilities in utilization management and care coordination as well as maintaining part-time inpatient patient care responsibilities at MLKCH. The expectation is for the PA role to be a dedicated .40 FTE. In this capacity, the PA is expected to interact regularly with the Senior Director of Care Management, other care management staff and health care team members to discuss selected cases and make recommendations for care. In so doing is interacting with medical staff members and medical directors of third party payers to discuss the needs of patients and alternative levels. The PA acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.
Responsibilities
- Works and collaborates in a dyad partnership with the Senior Director of Care Management to balance advocacy and support for patients, families, practitioners and professional staff and the organization that he/she is serving.
- Conducts clinical reviews on cases referred by care management staff and/or other health care professionals to meet regulatory requirements and in accordance with the hospitals objectives for assuring quality patient care and effective, efficient utilization of health care services.
- Serves as associate chair of the utilization management committee and assists the chair to advance quality, safety, key performance indicators and financial targets.
- Assists care management staff with patient transfer needs to alternative levels of care when required.
- Exhibits excellent and timely follow up of communication amongst patients, families, care managers, physicians and payors.
- Uses information from the current utilization management software program as needed for decision making related to patient admission or observation status.
- Collaborates with care management for cases that do not meet the current utilization management software program for admission criteria and documents discussions with physicians as needed.
- Facilitates peer-to-peer discussion and clinical documentation opportunities.
- Assists when necessary in mediation amongst different departments, teams, or individuals involved with the patient's episode of care.
- Assists medical and professional staff with education regarding DRG LOS, denials, clinical documentation, practice guidelines within the EMR and any regulatory changes.
- Maintains current physician advisor knowledge of regulatory and practice changes.
- Other duties and/or projects as assigned.
Requirements
- Completed MD or DO accredited residency program.
- Four (4) years in the health care setting and in a managed care environment with Hospitalist experience preferred.
- Minimum of five (5) years of clinical practice experience following the completion of residency or fellowship training.
- Experience identifying best practices, clinical utilization and care management preferred.
- Active and unrestricted License to practice medicine in the State of California.
- Board certified in a specialty approved by the American Board of Medical Specialties (ABMS).
- Is actively working in a patient care role as a hospitalist, emergency medicine physician, intensivist, anesthesiologist, surgical or medical specialist at MLK Community Hospital.
Nice-to-haves
- Experience identifying best practices, clinical utilization and care management preferred.
