Woodhull Medical and Mental Health Center is attuned to the healthcare issues that matter to the people of North Brooklyn. Woodhull focuses on preventing disease and promoting healthy lifestyles by reaching out to the community at various locations.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

PURPOSE OF POSITION:

The Physician Advisor (UM PA) will provide a professional link between medical staff, the Case Management, and Hospital Management.

AREAS OF RESPONSIBILITIES:

Serves the hospital through teachings, consulting, and advising, the inpatient units Providers, and ER on matters regarding over and under-utilization of resources, medical necessity – adherences to in-patient care guidelines for admission and continued stay, compliance rules and regulations. B) The UM PA will also assist the hospital in recovering lost revenue, maintain regulatory compliance, decrease costs by minimizing medical necessity denials, and achieving appropriate lengths of stay.

SUMMARY OF DUTIES AND RESPONSIBILITIES:

• Daily performance of reviews requiring physician level expertise and intervention beyond that achievable by the UR/Case Manager level of review.
• Determines medical necessity/ appropriateness for in-patient setting.
• Provides peer review of cases to achieve optimal clinical resource outcomes including, but not limited to, monitoring LOS management, and working collaboratively with the physicians to achieve targeted discharge dates.
• Insures that profession integrity is adhered to in all phases of the review process.
• Provides feedback and education to other members of the medical staff and support staff on opportunities for documentation improvement and/or medical necessity.
• Participates in the development of criteria/guidelines of clinical materials.
• Participates in ongoing physician education regarding clinical documentation and adherence to guidelines/criteria for in-patient care.
• Reviews adverse determinations to assist the clinician in rebutting the cases to facilitate a positive outcome.
• Intervenes with physicians when necessary to ensure prompt compliance with appropriate documentation change requests and/or justification of medical necessity.
• Peer-to-Peer Appeals: Review the medical record of selected inpatient cases for which the payer denied inpatient authorization and complete or ensure timely completion of an in-person verbal peer-to-peer appeal of the payor’s decision to the payor’s medical director or designee.
• Discuss issues related to medical necessity, documentations and physician responses to queries with the department chair, as required by CMS CoPs.
• Provides education and assistance to the UR/Case Managers on questions of documentation and medical necessity.
• Contributes to the development/implementation of policies and procedures, as needed.
• Upon identification of patterns and trends, works with the clinical staff to assist with corrective action.

• Qualification for Central Office.

# Qualification for Health Care Facility.
1. a. A Baccalaureate Degree in Public Administration, Public Health or Health Care Specialization; and,
b. Five* years or four# years of increasingly responsible experience in hospital administration, with particular emphasis on development and evaluation of health care delivery services; or,
2. a. A Master's Degree in Public Administration, Public Health or Health Care Specialization; and,
b. Four* years or three# years of increasingly responsible experience in hospital administration, with particular emphasis on development and evaluation of health care delivery services.

Please be advised that proof of Covid-19 vaccination is required prior to hire.

If you wish to apply for this position, please apply online by clicking the "Apply Now" button.

NYC Health and Hospitals offers a competitive benefits package that includes:

• Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
• Retirement Savings and Pension Plans
• Loan Forgiveness Programs for eligible employees
• Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
• College tuition discounts and professional development opportunities
• Multiple employee discounts programs