Description The Physician Advisor (PA) serves as a clinical resource to the medical staff and CM/SW by providing identification, facilitation and resolution of utilization issues. The PA role has a matrix reporting structure which includes Corporate Physician Advisor and Corporate CQIO , as well as entity CMO and CEO. The Physician Advisor addresses the following issues: Federal and state compliance, documentation supporting coding/medical necessity/clinical validation, appropriate level of care, length of stay, hospital utilization and quality issues. In collaboration with admitting physician, healthcare team, and case management , the PA proactively manages cases at the point of entry and through the hospital stay , to ensure the patient is placed in the proper level of care classification based on medical necessity, severity of illness and risk of mortality . The PA ensures compliance with CMS for appropriate billing . The PA conducts post-discharge reviews related to payer audits. Promotes understanding and cooperation between the medical staff through communication, collaboration and education. Facilitate improvements in clinical practice to achieve better performance, improved cost, reduced length of stay, fewer readmissions, and superior patient care.
Qualifications:The Physician Advisor (PA) serves as a clinical resource to the medical staff and CM/SW by providing identification, facilitation and resolution of utilization issues. The PA role has a matrix reporting structure which includes Corporate Physician Advisor and Corporate CQIO , as well as entity CMO and CEO. The Physician Advisor addresses the following issues: Federal and state compliance, documentation supporting coding/medical necessity/clinical validation, appropriate level of care, length of stay, hospital utilization and quality issues. In collaboration with admitting physician, healthcare team, and case management , the PA proactively manages cases at the point of entry and through the hospital stay , to ensure the patient is placed in the proper level of care classification based on medical necessity, severity of illness and risk of mortality . The PA ensures compliance with CMS for appropriate billing . The PA conducts post-discharge reviews related to payer audits. Promotes understanding and cooperation between the medical staff through communication, collaboration and education. Facilitate improvements in clinical practice to achieve better performance, improved cost, reduced length of stay, fewer readmissions, and superior patient care.Degrees:
Licenses & Certifications:
- Medical Doctor.
- ABQAURP Physician Advisor Sub-Specialty Certification.
- Osteopathic Physician.
Additional Qualifications:
- Maintains active Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) license.
- If license is not a state of Florida license, active State of Florida License must be obtained within one year of hire/job entry.
- Certification as Physician Advisor by a national physician advisor organization or American Board of Quality Assurance and Utilization Review Physicians [ABQAURP] certification or similar must be obtained within one year of hire.
- A minimum of 3 years work experience as practicing physician, with experience performing case reviews, and experience using MCG and/or Interqual criteria.
- Knowledge on application of CMS 2 Midnight Rule, and Condition of Participation, and inpatient billing requirements.
- Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines.
- Ability to communicate effectively in both oral and written form.
- Ability to handle difficult and stressful situations with critical thinking and professional composure.
- Ability to understand and follow instructions.
- Ability to exercise sound and independent judgment.
- Knowledge and skill in use of job appropriate technology and software applications.
- Maintains additional education in CMS guidelines, quality and utilization management through continuing medical education programs and self-study.
Minimum Required Experience: 3 YearsDegrees:
Licenses & Certifications:
- Medical Doctor.
- ABQAURP Physician Advisor Sub-Specialty Certification.
- Osteopathic Physician.
Additional Qualifications:
- Maintains active Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) license.
- If license is not a state of Florida license, active State of Florida License must be obtained within one year of hire/job entry.
- Certification as Physician Advisor by a national physician advisor organization or American Board of Quality Assurance and Utilization Review Physicians [ABQAURP] certification or similar must be obtained within one year of hire.
- A minimum of 3 years work experience as practicing physician, with experience performing case reviews, and experience using MCG and/or Interqual criteria.
- Knowledge on application of CMS 2 Midnight Rule, and Condition of Participation, and inpatient billing requirements.
- Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines.
- Ability to communicate effectively in both oral and written form.
- Ability to handle difficult and stressful situations with critical thinking and professional composure.
- Ability to understand and follow instructions.
- Ability to exercise sound and independent judgment.
- Knowledge and skill in use of job appropriate technology and software applications.
- Maintains additional education in CMS guidelines, quality and utilization management through continuing medical education programs and self-study.
Minimum Required Experience: 3 Years
