Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

Duties and Responsibilities:

Inpatient Clinical Optimization: Care Coordination, Progression, and Variation

1.      Regulatory and Standardization Initiatives

• Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), discharge planning (DP), LOC and clinical documentation.
• Works with Corporate Compliance to interpret new regulatory and compliance requirements and develops standard system-wide implementation plans and policies.
• Works with system Care Management (CM) leadership and Catholic Health Physician Advisors (as needed) to understand and standardize the implementation of CM processes and policies, as well as the Physician Advisor role, activities and expectations.
• Collaborates with CM and CDI departments at the system and facility level in developing and implementing standardized policies.
• Maintains current knowledge of federal, state, and payor regulatory and contract requirements, and ensures facility and system Physician Advisors maintain this knowledge as well.
• Works with Catholic Health Physician Advisors to assess health information technology operational functionality and escalates functional issues as identified.
• Works to ensure initial or continued accreditation through the following:
  • Ensure Joint Commission and other accrediting body requirements specific to care coordination are fulfilled, but also understand the linkage between care coordination department’s requirements and those of the integrated delivery system.
  • Collaborate with colleagues in quality and other departments to ensure all accrediting body requirements are met
• Maintains competence and professional development. Maintains license, certification or registration as required. Meets continues education requirements.
• Demonstrates behaviors that support performance improvement activities.
• Performs other duties and attends committees as requested.

2.      Monitoring and Support for Catholic Health Physician Advisors

• Provides structured feedback to Physician Advisors through annual performance evaluation.
• Monitors Physician Advisor performance dashboard with Key Performance Indicators (KPIs).
• Responsible for monitoring dashboards and other metric reporting to inform alignment to system-wide goals. Data for dashboarding and metrics to be updated on a consistent basis.
• Summarizes data on a monthly basis, in collaboration with the UR department, and presents to Physician Advisors during the monthly Physician Advisor meeting.
• Attends hospital Utilization Management (UM) committees.
• Supervises the Facility Physician Advisors.
• Observes Catholic Health Physician Advisors and provide feedback for standardizing the Catholic Health Physician Advisor role across the system.
• Serves as a resource for Catholic Health Physician Advisors to provide guidance and assistance.
• Provides coaching to Catholic Health Physician Advisors.
• Prepares and leads monthly Physician Advisor meeting.

3.     Training and Education

• Responsible for hiring and managing Physician Advisors, along with developing and monitoring compliance with an educational program.
  • Collaborates with management in recruiting new Catholic Health Physician Advisor hires.
  • Trains new Physician Advisor hires.
  • Creates a professional development plan for Catholic Health Physician Advisors.
• Ensures education and training is provided to reinforce inter-rater reliability (i.e., consistency of determinations), as necessary.

Minimum Qualifications:

1.      Minimum Education/Training Required:

• Graduate of an accredited medical school.
• Completion of specialty residency (i.e., Internal Medicine, Emergency Medicine).

2.      Experience:

• Five years recent experience in clinical practice in a hospital strongly preferred.
• Two years administrative background as physician manager preferred.
• Previous experience as a physician advisor preferred.
• Experience leading large-scale change efforts preferred.
• Experience in academic medicine, if applicable.

3.      License, Registration or Certification Required:

• Board Certified/Eligible Physician licensed in the state of New York, as applicable.
• Certification by American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred.

4.      Knowledge, Skills and Abilities:

• Strong clinical acumen.
• Knowledge of care management principles, processes, and their practical application preferred.
• Working knowledge of third-party payor guidelines/medical necessity criteria such as InterQual® (i.e., knowledge of admission criteria for all levels of care).
• Experience with denials management.
• Knowledge of clinical, quality, and administrative facets of the healthcare industry.
• Familiarity with clinical documentation requirements.
• Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building this knowledge through experience and partnership with Care Management.
• Excellent communication and presentation skills (both written and oral).
• Teaching and coaching skills.
• Analytical ability and problem-solving skills.
• Working knowledge of electronic medical record (i.e., Midas, Epic).
• Knowledge of process improvement methodology.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.