Carilion Clinic, headquartered in Roanoke, Virginia is recruiting for a full-time Lead Internal Physician Advisor to serve as the physician expert providing support to the internal physician advisor (IPA) team. Oversees program support for utilization management activities to include but not limited to second level reviews, peer to peer communications, level of care determination, continued stay and length of stay decisions. Functions as a consultant in resource management to the IPA team. Reinforces evidence-based medicine best practices and adheres to criteria-based guidelines in the Carilion Clinic Utilization Review Plan. Ensures the IPA team is applying consistent clinical judgement and review process outcomes to meet The Joint Commission and other accrediting agencies requirements specific to care coordination. Collaborates with Hospital Care Management and Quality department leadership to identify gaps in physician practice related to standards and regulations and develops action plans to address identified gaps in regulatory requirements. Supports the IPA team by serving as an administrative liaison between the hospital administrators, clinical staff, and support personnel in order to ensure regulatory compliance. Advises physicians on medical necessity and assists hospital leadership in meeting overall organizational goals related to providing efficient and safe patient care.
Qualified candidates must have a degree from an accredited medical school with completion of an accredited residency. Posses a strong clinical acumen. Knowledge of care management principles, utilization review processes and their practical application under current acute care InterQual guidelines. Working knowledge of third-party payer guidelines and commercial payer requirements of medical necessity criteria. Candidates must demonstrate excellent written and oral communication and presentation skills. Ten years recent experience in a hospital clinical practice with five years administrative/physician management strongly preferred. Previous experience as a Physician Advisor is required.
Carilion Clinic is the largest not-for-profit integrated health system in western Virginia, serving 1.5 million people. Carilion includes seven hospitals, 220+ practice locations, and 24 GME programs with 750+ physicians in over 75+ specialties. Carilion is a physician-led, collaborative, interdisciplinary Integrated Healthcare Delivery System with a common philosophy of patients first. In 2007, Carilion partnered with Virginia Tech to create the Virginia Tech Carilion School of Medicine (VTCSOM) and the Fralin Biomedical Research Institute at VTC. The position includes the opportunity for academic appointment to VTCSOM, and research interests are supported.
Roanoke is a multicultural metropolitan area of over 300,000, located at the southern tip of Virginia's spectacular Shenandoah Valley, surrounded by the beautiful Blue Ridge Mountains and the stunning 22,000-acre Smith Mountain Lake. The area offers exceptional outdoor activities but also extensive sports and cultural activities from fine dining, to multiple musical venues and playhouses, to symphonies, opera and ballets. Access to major air travel hubs is convenient through the Roanoke Blacksburg Regional Airport. The weather features mild winters, an abundance of sunshine, and extended spring and autumn seasons. The region features highly ranked schools and universities, and has been coined “the best kept secret in the east.”
Carilion Clinic is an affirmative action and equal opportunity employer. We embrace a diverse workforce and provide equal employment opportunities to all qualified candidates without regard to Race, Color, Religion, Sex, National Origin, Protected Veterans.