Job Purpose

The Physician Advisor performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. The Physician Advisor works closely with the Client’s medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to recommend methods to optimize use of hospital services for all patients while also ensuring the quality of care . This includes identifying opportunities to optimize length of hospital stay and efficient management of resources, insuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.

Duties and Responsibilities

• Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management department in a timely fashion
• Provides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management
• Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable
• Maintains accountability for achieving case management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care
• Demonstrates positive outcomes through interventions with attending or consulting physicians that delay care and affect the length of stay or avoidable delays, etc.
• Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment
• Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested
• Meets production standards within established time requirements. Work product and performance meets quality standards.
• Achieve performance goals as outlined in employment agreement
• Maintains confidentiality of patient care and business matters

Qualifications

• 3+ years working as a Physician Advisor performing case reviews
• Basic technical skills with Hospital EMRs and Microsoft Office and Teams a must
• Hold and maintain an unrestricted medical license and Board Certification
• Possess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety
• Possess a working knowledge of (Hospital) organization & case management operations and administrative standards and policies
• Strong computer skills and working knowledge of the EMR
• Familiarity with MCG/InterQual placement status criteria is preferred
• Member of the American College of Physician Advisors (ACPA) preferred
• Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred
• Physician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and Utilization
• Review Physicians, Inc. (ABQAURP) preferred

Other Skills or Special Abilities

• Excellent customer service and interpersonal skills and the utmost professionalism is required
• Able to effectively present information, both formal and informal
• Strong analytical skills
• Strong written and verbal communications skills with all levels of internal and external customers
• Strong organizational skills and ability to set priorities and multi-task, demonstrates flexibility, teamwork, and is accustomed to change in the healthcare environment
• Demonstrates ability to drive results and produce outcomes

https://recruiting.paylocity.com/Recruiting/Jobs/Details/785296