Physician Advisor

Description Please note: Experienced Physician Advisor's only and no part time inquiries* The Physician Advisor (PA) will drive quality performance across the organization by communicating with hospital physicians, utilization management, case management, CDI, the denials team, and quality staff. The PA conducts case reviews to ensure compliance, appropriate and accurate clinical documentation, and appropriate utilization of health care services. The PA will meet with hospital personnel and medical staff when needed to provide education and expertise. The PA acts as a consultant and resource for attending physicians regarding appropriate status, utilization of resources, need for continued hospitalization, compliance concerns and tracking and reporting of quality and complications. The PA will also interact with medical directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care. Requirements GENERAL SUMMARY: The Physician Advisor (PA) will drive quality performance across the organization by communicating with hospital physicians, utilization management, case management, CDI, the denials team, and quality staff. The PA conducts case reviews to ensure compliance, appropriate and accurate clinical documentation, and appropriate utilization of health care services. The PA will meet with hospital personnel and medical staff when needed to provide education and expertise. The PA acts as a consultant and resource for attending physicians regarding appropriate status, utilization of resources, need for continued hospitalization, compliance concerns and tracking and reporting of quality and complications. The PA will also interact with medical directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care. Duties And Responsibilities Utilization Management Functions Reviews medical records of patients identified by the UM team or as requested by the healthcare teamPerform status determinations including 2nd level reviews and continued stay reviews for traditional Medicare patients and all other payorsReview Code 44 casesAssist with length of stay managementWork with case management and the interdisciplinary team to ensure appropriate continuity of care and reduce readmissionsCommunicate with the medical staff through secure email, secure texting applications, phone calls and face to face interactions to relay important information and provide educationAct as a liaison between Utilization Management/Case Management and providers to collaborate on appropriate plans of careReview and suggest improvements related to resource allocationOptimize coordination of care processesProvide guidance to ED Physicians and the UM/CM team regarding alternatives to acute care Denials Management Functions Review denials and author appeal letters as neededPerform peer to peers with payorsAct as a liaison with payors to facilitate approvals and prevent denials or carved out days when appropriateOther duties as assigned. KNOWLEDGE, SKILLS, AND ABILITIES: Abilities may be accessed through written, verbal, and other evaluation methods. Expertise in Utilization Management preferredStrong interpersonal skillsExcellent written and verbal communication skillsAbility to work independentlyAbility to build relationships with key hospital team members WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS: List preferred/required work experience, education, and certifications. MD or DO Current, unrestricted medical license in state of residence Demonstrated ability to build rapport with medical staff and hospital leadership Strong computer skills and working knowledge of EMRs 1-3 years of Physician Advisor experience and clinical experience in a hospital-based setting Preferred Qualifications Board Certified / EligibleCCDS or CDIPCCSCHCQM certification (ABQAURP) Working Conditions And Physical Requirements Conditions typically associated with an office environment. While performing the essential duties and responsibilities, the employee is regularly required to talk or hear. May be frequently required to sit, stand or walk. Moderate to prolonged reading, typing, and computer work. Ability to perform tasks involving physical activity that may include lifting 25 pounds. Subject to exposure to all environmental hazards associated with healthcare and office work.