The Medical Director Physician Advisor Program is responsible for providing leadership oversight to Rochester Regional Health’s Physician Advisor Program by providing overall guidance and direction to the appropriate stakeholders. This physician leader is responsible for the implementation of a strategic plan for physician collaboration with the Utilization Management Program, including level of care (LOC) determination, and denial & appeal (D&A) management by providing overall guidance and oversight to the appropriate stakeholders. This individual shall co-lead a team of physician advisors who will participate in the above activities on a case-by-case level, LOC, and D&A teams, and engage the medical staff in participating in these processes through UMD-Liaisons. This individual will assist the Vice president of Health Informatics, CMIO, and CMO in achieving other goals like compliance, audit management, clinical efficiency, consideration of artificial intelligence where warranted, and systems integration as needed. Additionally, this individual serves as a subject matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient-focused and cost-effective medical care.

Key Responsibilities      

• Strategic planning for the continued success and growth of the Physician Advisor (PAd) program
• Participate in PAd activities on a case-by-case level, support LOC,  appeal, or compliance decisions (perform tasks described in Associate PAd and PAd job description) as necessary
• Oversee the interactions between the PAd program with UMD teams and provider teams (via UMD-Liaison): on group-to-group and person-to-person levels
• Collaborate with the Vice President and Operations Director to guide and oversee budgetary/staffing decisions related to the program cost center
• Hire and train PAd-s as necessary
• Develop educational programs regarding LOC, D&A, compliance issues for Physician Advisors, and education and engagement campaigns for the medical staff
• Act as subject matter expert in complex utilization review and management decisions
• Act as subject matter expert in Medicare DNB reviews
• Develop a maintenance and QI program for the PAd-s (education, team building, performance reviews)
• Development & optimization of uniform processes (operations, interfaces with providers, IT/data entry methods, reference materials, risk calculators, note and letter templates, portal site) across the LOC, D&A teams, and engaging providers in this continuum.
• Optimization of capturing, analyzing, and reporting data to create relevant, timely, and accurately attributable metrics. Metrics should target the performance of clinicians, PAd-s, UM support services, and contractors. Metrics should also target specific conditions, processes, groups, and locations
• Act as subject matter experts in pre-surgical and post-surgical account reviews to attain favorable outcomes
• Engagement and dispute resolution with payors (MVP, UHC, etc.) at the executive leadership level
• Analyzing payor patterns and assess impacts to RRH. Engage with contracting, legal and compliance departments as needed to reduce the unfavorable impacts to RRH
• Represent RRH at Administrative Law Judge (ALJ) Hearings
• Engage with external entities like HANYS, Optum (Interqual), DFS, ESMSEF, IPRO, etc.,
• Integrating advanced technology solutions into current utilization review and management workflows
• Optimize performance benchmarking (PEPPER, Premier, Treo, SHM, AB, etc.), prepare for external reviews (audits, payors...), and seek new strategies for the UM and PAd programs
• Collaborate with analysts, Hospital capacity management, Revenue cycle department, Quality & Safety institute, Health Informatics, GRIPA, and consultants to achieve the above goals
• Develop a graduate medical education curriculum for physicians in training
• Develop a strategic plan to establish the RRH PAd program as a thought leader across the local and national levels
• Collaborate with VPs and other operational leaders for awareness and value of program to keep relevancy
• Communication / Presentation strategy and skills and data literacy and visualization
• Operational tasks as listed in additional document (is it different than 3)
• Incorporate legal, regulatory, and financial tasks from JD and Strategic Plan
• Participate in PAd activities on a case-by-case level, support LOC, CDI, appeal, or compliance decisions (perform tasks described in Associate PAd and PAd job description) as necessary
• Serve as a back-up for your fellow Medical Director in the Physician Advisor Program as needed
• Other duties as assigned

Desired Attributes:       

• Master’s degree in business or healthcare administration
• 2 years of progressive program/project development and quality improvement experience
• High level of organizational & analytical skills to manage projects, timetables, and implementations
• High level of collaboration, team building, and inter-disciplinary skills needed to accomplish complex activities
• Advanced interpersonal skills to develop effective teams and manage, direct and coordinate team activities
• Ability to influence, negotiate and motivate collaborators
• Able to develop meaningful metrics, data collection, and analysis
• Keen understanding of the PDSA cycle implementation
• Must be able to positively communicate and work with professionals at all levels of the organization

Minimum Qualifications

• Physician, M.D. or D.O.
• 3 years of physician advisor experience
• 2 years of clinical/organizational leadership experience
• Required licensure and certification skills:           
  • Licensed in NYS and practicing acute care clinical medicine at least 20% of the time within RRH
  • Board certification in a clinical specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association
  • Board certification in HCQM (ABQAURP) or ability to within one year

Pay Transparency

In addition to the base pay range, certain provider positions may be eligible for variable compensation in accordance with health system pay practices. This may include: productivity and/or value based clinical incentives, bonus compensation, or other forms of variable pay.

Rochester General Health System is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran