Job Title
Reaching out to see if anyone has unique job titles for 4 year degree healthcare professionals (RN, OT,PT, Resp Therapist, etc..) overseeing a team of Physician & APP Advisors in a healthcare system? We have nearly 10-11 Physician & APP Advisors with a program manager currently overseeing. The title is really not fitting of the role as some of the duties align with a manager title. Looking for titles that are recognized within the industry. Thanks in advance for your guidance.
Clinical Oversight:
- Review complex patient cases submitted by physician advisors and other healthcare professionals to ensure accurate clinical assessments and appropriate medical necessity determinations.
- Provide guidance on complex clinical scenarios and interpretation of payer guidelines.
- Monitor trends in denial rates and identify areas for improvement in clinical documentation and care management.
Team Management:
- Recruit, hire, and train new physician advisors and other healthcare professionals.
- Assign cases to physician advisors and healthcare professionals based on expertise and workload.
- Conduct performance evaluations and provide ongoing feedback to physician advisors and healthcare professionals.
- Foster collaboration and communication within the physician advisor team and with other healthcare professionals.
Compliance and Regulatory Management:
- Stay updated on current payer regulations and guidelines related to medical necessity and utilization review.
- Ensure the Physician Advisor team and other healthcare professionals adhere to all relevant compliance standards and policies.
- Monitor and address potential compliance risks within the department.
Quality Improvement:
- Develop and implement strategies to improve clinical documentation quality and coding accuracy.
- Analyze denial trends and identify opportunities to reduce denials through clinical interventions and education.
- Collaborate with other departments, such as case management and quality improvement teams, to optimize patient care.
Stakeholder Collaboration:
- Establish strong working relationships with clinical leadership, billing department, and other healthcare providers.
- Communicate effectively with payers regarding appeals and denials.
- Educate clinicians and other healthcare professionals on appropriate utilization of healthcare resources and documentation practices to minimize denials.
Reporting and Analysis:
- Generate reports on key performance indicators (KPIs) related to utilization management, denial rates, and cost savings.
- Analyze data to identify areas for improvement and implement corrective actions.
- Present findings to leadership to inform strategic decision-making.
Required Skills:
- Strong clinical knowledge and experience in a relevant medical specialty.
- Expertise in payer regulations and medical necessity guidelines.
- Excellent communication and interpersonal skills to collaborate with diverse healthcare professionals.
- Leadership abilities to manage a team of physician advisors and other healthcare professionals.
- Data analysis and reporting skills to identify trends and inform decision-making.
Tracy Boldt BSN CCDS-O
tracy.boldt@essentiahealth.org
Essentia Health System