Physician Advisor II - Remote

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
• 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
• Maintains confidentiality of patient care and business matters
• Meets production standards within established time requirements. Work product and performance meets quality standards
• Achieve performance goals as outlined in employment agreement
• Participates in required orientation and training related to the Physician Advisor role
• Participates in the peer review process as may be necessary or requested
• Maintains medical licensure and board certification in good standing
• Manages client relationships for PAOC, directing quarterly report creation and JOCs (in concert with the Director of Operations), achieving customer satisfaction and retention
• Contributes to execution of PAOC’s Quality program and continuous PA development
• Provides education to client facilities’ staff on a variety of relevant topics
• Mentors and trains new Physician Advisors as well as existing Physician Advisors to ensure the highest possible consistency and quality for PAOC determinations
• Serves as Team Lead for Physician Advisors for Dashboard management as scheduled
• Fulfills additional duties as needed within the Physician Advisor II role

Qualifications

• Specialty Board Certified
• Licensed to practice medicine in the US
• 3+ years working as a Physician Advisor or UR/UM Medical Director 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
• 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
• Proficiency in Microsoft Office Suite
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required