Saint Thomas Health Physician Adviser Opportunity

Located in Nashville, TN and our surrounding Middle Tennessee Service Area

Job Summary:

Provides consultation to the medical staff, administrative staff, utilization review and care management personnel regarding appropriate admission status, payer guidelines, denials management, optimal medical documentation, utilization management, care coordination, compliance with Medicare regulations, and optimal delivery of healthcare services.*

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About Saint Thomas Health

Saint Thomas Health (STH) is the leading faith-based health care system in Middle Tennessee, with nine hospitals, physician practices and facilities.* STH is a part of Ascension, the largest non-profit health system in the U.S. and the world's largest Catholic health system. We are committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable.* STH also includes Saint Thomas Medical Partners, a physician-led medical group providing primary care, specialty services, medical imaging, outpatient services and community-based medical practices in 95 locations through Middle Tennessee and Southern Kentucky.* If caring is your calling, join our team today.

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About Ascension Health

In Tennessee, Ascension's Saint Thomas Health operates nine hospitals in addition to a comprehensive network of affiliated joint ventures, medical practices, clinics and rehabilitation facilities that cover a 68-county area and employees more than 8,000 associates.* Serving Tennessee for 15 years, Ascension is a faith-based non-profit health system which is the largest in the U.S. and the world's largest Catholic health system, operating 2,500 sites of care * including 141 hospitals and more than 30 senior living facilities * in 24 states and the District of Columbia.

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Requirements

• Provide education to physicians and ancillary medical staff regarding Medicare regulatory guidelines and commercial payer requirements
• Daily involvement in concurrent review of Medicare admissions, observation patients, and commercial payer inpatient denials
• Perform peer-to-peer reconsideration with commercial payers
• Assist our UR team with denials management including reconsideration, condition code 44 process, and case-specific physician education
• Assist with administrative teams to effectively manage length of stay and utilization of resources
• Assist with our finance and administrative teams to track appropriate metrics, interpret those metrics and develop appropriate clinical pathways, procedures, and protocols to achieve our system goals
• Assist with care coordinators on difficult discharge situations, helping them arrange the appropriate post-acute services
• Act as a liaison between administrative, finance, and clinical teams
• Work directly with network physicians by providing input and guidance related to the physician's methods, procedures, and utilization of resources
• Develops strategies and processes to reduce denials and audits
• Be a consultative resource for physicians, physician extenders, UR nurses, case managers, CDI specialists, administrative and finance personnel
• Medical record review and audit

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For additional information or to apply please contact: Scott Watson