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Cone Health, a not-for-profit health system, in Greensboro, North Carolina, is seeking an experienced FM/IM physician to serve as its Clinical Physician Advisor. General Requirements:
- M-F, 8am-5pm
- Ensure appropriate denials management and utilization of health system resources.
- Serve as a thought partner and resource to members of the medical staff, clinical staff, utilization management team members, CDI team members, Transitions of Care team members, case managers, and senior leadership.
- Provide regular feedback to physicians and all other stake holders regarding level of care, length of stay, and potential quality issues.
- Provide guidance on individual cases and aggregate level to cultivate efficiency related to patient care delivery providing medical case review, utilization and quality review and submit recommendations, advice and liaison services concerning quality and cost-effective patient care.
- Review cases that indicate a need for issuance of a hospital notice of non-coverage (HINN)/Important Message from Medicare (IM).
- Effectively present information, both formally and informally
- Strong analytic skills, written and verbal communication skills, organizational skills
Qualifications: Educational/Licensure Requirements: Doctor of Medicine (MD), Doctor of Osteopathy (DO) or equivalent degree and board certified in area(s) of specialty, NC medical license, full unrestricted DEA, Cone Health medical staff membership, and other employment requirements. Required: Physician Advisor Certification, Graduate of Physician Leadership Academy (Cone Health) or equivalent degree with education/preparation in healthcare administration and/or leadership development. Experience Requirements: Five (5) years of progressive clinical demonstrating clinical skills, quality improvement, utilization management experience and team development. Required: 1-3 years in Quality Improvement; 1-3 years in Utilization Management. World Class Care: Cone Health is a not-for-profit 5 hospital system with 1100+ beds. We achieve top decile performance and quality through our Physician Engagement. A Place to Call Home: Greensboro and the surrounding North Carolina communities are centrally located in what's known as the "Triad of NC". Greensboro is one of the best places to live and play in NC... where you can get to know your neighbors and a place to call home. There are outstanding schools, wonderful cultural events, great sports, golf, eclectic dining, and more. The 4-season climate will inspire you to enjoy the outdoors year-round! For great travel, we have 3 airports (2 have international flights) that service our areas and for weekend getaways, it is an easy drive to the Blue Ridge Mountains and the Carolina coast. For more community information, please visit: Greensboro Life / Greensboro Professionals / Greensboro |
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?Reviews medical records of identified patients to assist with the level of care and length of stay determination.
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?Interacts with medical staff members and medical directors of third-party payers to discuss the patient needs and alternative levels of care.
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?Provides education to physicians and other clinicians on regulatory requirements, appropriate utilization of alternate levels of care, community resources and end of life care.
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?Develops strategy and processes to reduce denials and audits. Assists with appeals. Reviews and offers suggestions related to resources and service management.
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?Utilizes hospital data sources to identify and analyze patterns of over or under-utilization of services, quality metrics and makes recommendations towards achievement of those goals.
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?Suggests recommendations of treatment of specific cases and discusses about the same to the health care team.
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?Acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.
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?Reviews cases retroactively to determine appropriateness of Part B billing versus appeal.
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Equal Opportunity Employer At Cone Health, we strive to create a welcoming atmosphere that celebrates a diverse and unique workforce. We believe in offering equal opportunities for employment to all applicants and employees, regardless of their race, religion, age, sex, sexual orientation, gender identity, veteran's status, ethnicity, national origin, disability, color, or any other characteristic protected by law. Our hiring and employment choices are based on each individual's qualifications, skills and performance. We believe that by embracing the diversity of our team, we can better serve our patients, communities and each other.
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Cone Health
Apr 06, 2025