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Part-time Physician Advisor, Denials Management Danbury Hospital

Employer
Nuvance Health
Location
Danbury, Connecticut
Salary
Competitive salary and benefits, Paid time off, 401k match
Posted Date
Jun 30, 2019
Reference
735

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Specialty
Internal Medicine
Position Type
Permanent

Job Details

Western Connecticut Health Network is seeking a part-time Physician Advisor for Denials Management at Danbury Hospital. This is a non-clinical role for 20 hours per week and benefits eligible (pro-rated). The Physician Advisor shall develop expertise on matters regarding inpatient medical necessity, utilization review and levels of care, care progression, denial management, and compliance with governmental and private payer regulations.

Welcome to Western Connecticut Health Network, a comprehensive group of Hospitals, Medical Practices and Home Care designed to know our patients well. WCHN is comprised of Danbury, New Milford, and Norwalk Hospital, as well as Western Connecticut Home Care, and Western Connecticut Medical Group. We are united by our mission to improve the health and well-being of those who live in the communities we proudly call home. We believe our dedicated and talented employees are the cornerstone of providing the best in patient care, and we are seeking qualified and compassionate individuals to enhance the delivery of care to the communities we serve.

About Western Connecticut Health Network

Established in 1885, Danbury Hospital is a not-for-profit community hospital providing Greater Danbury area resident's convenient access to exceptional care. Danbury Hospital is part of Western Connecticut Health Network, which also includes New Milford and Norwalk Hospitals as well as over 70 outpatient practice locations. Danbury Hospital has 371 beds and is a Level II Trauma Center with approximately 70,000 ED visits per year. As a teaching hospital, we are associated with the University of Vermont College of Medicine, Yale University School of Medicine, Ross University School of Medicine, and American University of the Caribbean. Our Medical Group includes 400+ physicians and 140+ advanced practice providers, serving a geographically broad region throughout Western Connecticut and eastern New York.

Danbury, Connecticut, located in the foothills of the Berkshire Mountains and on the border of New York State, is about 70 miles northeast of New York City and 60 miles west of Hartford, CT. As part of the greater NY metropolitan area, the city of Danbury enjoys both proximity to New York City culture and access to a wide array of outdoor activities, including hiking, biking, fishing, and boating in state and regional parks and preserves. Home to Western Connecticut State University, Danbury has abundant local historical, cultural, educational, and recreational attractions. Surrounded by a number of quaint towns with scenic rolling hills, Danbury offers the convenience of contemporary urban life with the beauty of a country lifestyle. Boston, New York City, New Haven, and Hartford are easily accessible via train, car, or bus.   

Work for Us

Working for Western Connecticut Health Network (WCHN), comprised of Danbury Hospital; New Milford Hospital; Norwalk Hospital; Western Connecticut Medical Group; and Western Connecticut Home Care, you can make a meaningful difference in the lives of other people. Our Western Connecticut Health Network Department of Research and Innovation, focused on the field of molecular science and personalized medicine, ranks among our country's leading research organizations. Our Network offers many opportunities to grow your own skills and expertise – we offer competitive pay. 

Job Summary:

  • Appeal cases for which Danbury Hospital/New Milford and Norwalk Hospital have received payment denial from CMS and commercial carriers.
  • Identify opportunities for improving hospital systems/processes with the goal of increasing compliance with CMS regulations and thereby decreasing future payment denials.
  • Prepare effective appeals for cases denied by RAC for medical necessity, at the first, second and Administrative Law Judge levels, using evidenced based best practices and citing the latest appropriate literature for the specified denial.
  • Prepare effective appeals for cases denied by National Government Services ("pre-payment" denials) for medical necessity, at the first, second, and Administrative Law Judge Levels, using evidence-based best practices and citing the latest appropriate literature for the specified denial.
  • Prepare effective appeals for cases denied by commercial insurance carriers for lack of medical necessity or delay in service, using evidence-based best practices and citing the latest appropriate literature for the specified denial.
  • Prepare effective appeals for DRG readmissions and DRG downgrades as needed.
  • Perform Peer-to-Peer discussions with payer representatives.
  • Recognize and identify trends in denials and identify process improvement opportunities in Denial Management in an effort to increase reimbursement and reduce clinical denials.
  • Communicate effectively with all members of department team.
  • Fulfills all compliance responsibilities related to the position.
  • Performs other duties as assigned.

Job Requirements:

  • MD or DO degree from an accredited school of medicine or osteopathy with active CT State Medical License and Board Certification
  • At least five years’ of inpatient clinical experience.
  • Able to apply evidenced-based best practices. Able to work within departmental timelines. Strong clinical knowledge. Strong written and verbal communications skills with all levels of internal and external customers. Team Player/Collaborative. Computer proficient. Good problem solver. Organized. Professional.
  • Flexible schedule for 20 hours per week and excellent benefits eligibility (pro-rated for part-time status).
  • Previous physician advisor experience, preferred. Trained in Milliman and InterQual UR criteria, preferred.

For more info on position #735, contact Amy Rosoff

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Qualified Applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status, or any other classification protected under applicable Federal, State, or Local law. We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at: 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities

Company

Nuvance Health serves 1.5 million residents across New York and Connecticut and includes more than 2,600 aligned physicians, 12,000 employees, seven hospitals (Danbury Hospital, New Milford Hospital, Northern Dutchess Hospital, Norwalk Hospital, Putnam Hospital Center, Sharon Hospital, and Vassar Brothers Medical Center), a large network of primary care and specialty practices, and multiple affiliated organizations.

Company info
Website
Telephone
203-852-2640
Location
24 Hospital Avenue
Danbury
CT
06810
US

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