CDI Physician Advisor, Greater Sacramento Division

Organization: SHSO-Sutter Health System Office-Valley

About the Role

The Physician Advisor (PA) is a key member of the hospital's leadership team responsible for ensuring the effective, efficient utilization of health care services. The PA develops expertise in physician practice patterns, resource utilization, medical necessity, documentation best practices, level of care progression, denial management, and compliance with governmental regulations and commercial insurance contracts. This role strengthens the relationship between System Enterprise and the hospital to optimize Sutter Health Internal Physician Advisor Services (IPAS).

The Physician Advisor collaborates with medical staff, utilization management (UM) personnel, and Care Management (CM) teams to implement strategies that optimize hospital services, ensuring patients receive appropriate care with compliant documentation and accurate coding.

This is a hybrid role with some onsite requirements in the dedicated area.

Responsibilities

• Conducts clinical reviews on cases referred by UM/CM staff or other healthcare professionals to meet regulatory requirements and hospital objectives for quality patient care and efficient resource utilization.
• Meets with care management, UM staff, healthcare team members, and medical directors of third-party payers to discuss patient needs and alternative levels of care.
• Acts as a consultant and resource for attending physicians regarding the appropriateness of hospitalization, continued stay, and resource use.
• Serves as a resource for the medical staff on federal and state utilization and quality regulations.
• Liaises between Clinical Documentation Improvement (CDI) professionals, Health Information Management (HIM), and medical staff to facilitate accurate and complete documentation for coding, severity, acuity, risk for mortality, and DRG assignment.
• Reviews cases escalated by the CDI team for potential documentation opportunities and participates in the unanswered query escalation process.
• Meets regularly with CDI PA Medical Director, CDI Managers, and CDI Leads to discuss current areas of opportunity and unanswered queries.
• Provides clinical feedback and provider perspective to the CDI team to build program credibility.
• Develops, coordinates, and presents provider education focused on improving documentation accuracy and reflecting the quality of patient care, expected mortality, length of stay, and medical necessity.
• Shares key clinical documentation concepts and tailors education content to specific provider groups and specialties.
• Collaborates with subspecialty providers to create consistent definitions and documentation for complex conditions.
• Develops and participates in recognition processes for providers making significant positive impacts on the program.
• Helps develop clinically appropriate and compliant provider queries to clarify documentation.
• Evaluates current documentation systems, tools, and processes, recommending innovative improvements.
• Provides guidance and coaching to providers on using updated functionality effectively.
• Leads multidisciplinary and multi-departmental provider engagement strategies related to CDI strategic goals.
• Participates in Clinical Documentation Integrity Steering Committee and Quality Committees, as appropriate.
• Serves as a liaison between providers and the CDI team to address issues and questions, proactively managing stakeholder perspectives.
• Holds one-on-one meetings with physicians to address areas of opportunity and respond to questions.
• Identifies preferred communication methods for individual providers or provider groups.
• Regularly reviews key process and outcomes metrics related to the CDI program, including:
  • Process metrics: provider response rates, agree rates, response times, query trends.
  • Outcomes metrics: medical and surgical capture rates, capture rates by service line, DRG triplets and pairs, case mix index, expected mortality, observed-to-expected mortality ratio, CMS Star ranking, Vizient rankings, risk variable capture, Leapfrog rating.
• Develops action plans for non-responsive providers, providers with high disagreement rates, and service lines with risk variable capture opportunities.
• Reports performance data and significant issues to senior leadership.

Requirements

• Doctorate: Graduate of an accredited medical school.
• Certification & Licensure: MD (Doctor of Medicine) or DO (Doctor of Osteopathy) with an unrestricted medical license in the state of residence.
• 3 years of recent relevant experience.

Skills and Knowledge

• Quality Management & Performance Improvement:
  • Leads change in documentation practices to achieve organizational objectives related to quality improvement and revenue cycle initiatives.
  • Assists in creating and implementing documentation strategies for accurate reflection of care quality.
  • Applies knowledge of coding rules, risk adjustment, and quality reporting methodology to achieve organizational goals.
  • Elicits optimal value from documentation as a marker of care quality.
• Operations:
  • Reviews escalated cases for documentation opportunities and follows up on unanswered queries.
  • Provides clinical feedback to the CDI team to build program credibility.
  • Partners in developing and presenting provider education.
• Communication:
  • Serves as a liaison between providers and the CDI team, facilitating collaborative relationships.
  • Holds one-on-one meetings with physicians to address areas of opportunity.
  • Identifies preferred communication methods for providers or provider groups.
• Quality, Financial, and Data Management:
  • Reviews key process and outcomes metrics related to the CDI program.
  • Develops action plans for non-responsive providers and service lines with opportunities.
  • Reports performance data and significant issues to senior leadership.

Benefits

Eligible positions include a comprehensive benefits package.

Pay

Pay range is $121,056.00 to $193,689.60 annual salary. The compensation range may vary based on geographic location, candidate experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is one component of Sutter Health’s comprehensive total rewards program.

Schedule

• Shift: Days
• Schedule: Part-time (20 hours per week)
• Days of the Week: Monday - Friday
• Weekend Requirements: As needed