CDI Physician Advisor

We are so glad you are interested in joining Sutter Health! Organization SHSO-Sutter Health System Office-BayPosition Overview: The Physician Advisor (PA) is a key member of the hospital's leadership team charged with meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial management and compliance with governmental regulations and conditions of participation and commercial insurance contracts. The PA is responsible for establishing, maintaining and strengthening the relationship with System Enterprise and the hospital to appropriately optimize the use of Sutter Health Internal Physician Advisor Services (IPAS). The physician Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to develop and implement methods and strategies to optimize the use of hospital services. This includes care management processes that ensure patients are in the appropriate level of care with supporting documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on cases referred by UM/CM staff and or other healthcare professionals to meet regulatory requirements in accordance with the hospital objectives for assuring quality patient care and effective, efficient utilization of health care services. The PA meets with care management, UM staff and health care team members and medical directors of third-party payers to discuss the needs of patient's and alternative levels of care. The PA acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources. The PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations. The PA will act as a liaison between the CDI (Clinical Documentation Improvement) professional, HIM (Health Information Management ), and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk for mortality, in addition to Direct Report Groups (DRG) assignment. This is a hybrid role with some onsite requirements in the dedicated area.Job Description: Education Doctorate: Graduate of an accredited medical school Certification & Licensure MD-Doctor of Medicine OR DO-Doctor of OsteopathyUnrestricted medical license in state of residence Typical Experience 3 years of recent relevant experience. Skills And Knowledge Quality Management & Performance Improvement: Effectively leads change in behavior on the documentation needs of the medical staff and other clinical providers to achieve organizational objectives related to quality improvement and revenue cycle initiativesAssists with the creation and implementation of documentation strategies for accurate and complete reflection of the quality of careApplies knowledge of coding rules and regulations, along with understanding of risk adjustment and quality reporting methodology to achieve organizational goalsElicits optimal value from documentation as a marker of quality of care Operations:Reviews cases escalated by CDI team for potential documentation opportunitiesParticipates in unanswered query escalation process by following up with physicians electronically and in-person to obtain query responsesMeets regularly with CDI Director, CDI Managers, and CDI Leads to understand current areas of opportunity and discuss unanswered queriesProvides clinical feedback and provider perspective to CDI team to build credibility of the program and CDI staffPartners in the development, coordination and presentation of provider education:Focused on improving the accuracy of documentation and the reflection of the quality of patient care reported, expected mortality, expected length of stay, medical necessity and other documentation related outcomes.Shares key clinical documentation concepts and their importance for hospital and individual providersTailors education content and messaging to specific provider groups and specialtiesCollaborates with subspecialty providers to create consistent definitions and documentation around complex conditionsDevelops and participates in recognition process for providers that have made significant positive impacts to the programHelps to develop clinically appropriate and compliant provider queries to clarify documentationEvaluates current documentation systems, tools and processes and recommends innovative initiatives and improvementsProvides guidance and coaching to providers on how to use updated functionality effectivelyLeads multidisciplinary and multi-departmental provider engagement strategies related to CDI strategic goals and objectivesInvolved in Clinical Documentation Integrity Steering Committee and Quality Committees, as appropriate Communication Serves as liaison for providers and CDI team to address issues and questionsProactively manages each group’s perspectives and facilitates a collaborative relationship among stakeholdersHolds one-on-one meetings with physicians to address areas of opportunity and respond to questionsIdentifies preferred methods of communication for individual providers and/or provider groups Quality, Financial and Data Management:Regularly reviews key process and outcomes metrics related to the CDI program:Process metrics: provider response rates, agree rates, response times, query trends, among othersOutcomes metrics: medical and surgical capture rates, capture rates by service line, capture rates by DRG triplets and pairs, case mix index, expected mortality, observed to expected mortality ratio, CMS Star ranking, Vizient rankings and risk variable capture, Leapfrog rating, among othersDevelops action plans for non-responsive providers, providers with high disagreement, and service lines with risk variable capture opportunityReports performance data and significant issues to senior leadership DaysSchedule Job Shift: Part TimeDays Of The Week Monday - FridayWeekend Requirements: YesUnions As NeededBenefits: NoPosition Status ExemptWeekly Hours: 40Employee Status Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $278,428.80 to $445,494.40 / annual salaryThe compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.