[Hiring] Behavioral Health Physician Advisor @Carle Health

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Role Description

Carle Health is seeking a Physician Advisor to help oversee the efficiency of care for our Behavioral Health team over the West, Central, and East regions in Central Illinois.

• Part-time position (.5 FTE and 100% Virtual)
• Responsible for conducting clinical case reviews referred by the Utilization Management Team, the Case Management Team, the Clinical Denial Management Team, and other health care professionals.
• Participate in discussions with payer physicians to ensure efficient and appropriate utilization of hospital services for their assigned patient population.
• Serve as a consultant and resource for attending physicians in individual settings as well as group meetings related to hospital utilization, appropriate level of care, and continued stays.
• Participate in regular scheduled and ad hoc meetings related to utilization management, case management, and clinical denials management.
• Onboard new providers regarding utilization and case management objectives.
• Conduct medical record review for medical necessity of hospital admission, continued hospital stay, adequacy of discharge planning, and quality care management.
• Provide education to physicians and other clinicians related to improved clinical documentation, regulatory requirements, appropriate utilization, alternative levels of care, and community resources.
• Work collaboratively with the Clinical Denial Management team, the Utilization management team, and the Clinical Denial Management team in defending payor claims denials for medical necessity through coordination of and participation (when appropriate) in the appeal process.
• Function with or by the authorization of the Chief Medical Officer and work with the Utilization Management RN team, Clinical Denials Management team, and the Physician Advisor Team.
• Conduct clinical review on cases referred by Care Management staff/Social Work, Utilization management, and Clinical Denials Team in accordance with the hospital’s objectives for assuring quality patient care and effective, efficient utilization of health care services.
• Interact with Medical Staff members, APP Directors, and Medical Directors of payers to discuss the needs of patients and alternative levels of care.
• Act as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.
• Act as consultant and resource to the Medical Staff regarding federal and state utilization and quality regulations.

Qualifications

• MD/DO, board-certified in Psychiatry
• Active Illinois medical license or ability to obtain
• 5 or more years of Psychiatric Clinical practice experience required
• 1 or 2 years experience as a Physician Advisor or similar role

Benefits

• The compensation for this position is $160/hour.
• Comprehensive benefits package for team members and providers.