Job PurposeThe Physician Advisor performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. The Physician Advisor works closely with the Client's medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to recommend methods to optimize use of hospital services for all patients. This includes identifying opportunities to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.
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
- Meets productivity and quality standards within established time requirements. Work product and performance meets or exceeds quality standards.
- Achieve performance goals as outlined in employment agreement
- Maintains confidentiality of patient care and business matters
- Demonstrates behavior that supports the organization's mission. Participates in required orientation and training related to the Physician Advisor role
- Demonstrates commitment to meeting/exceeding strategic initiatives of organization
- Upholds the organization's values of teamwork and professionalism and applies Code of Conduct standards to all members of the healthcare team
- Facilitate, mentor, and educate other physicians regarding payer requirements
- Attends all meetings as requested by PAOC leadership
- Participate in the peer review process as may be necessary or requested
- Maintain medical licensure and board certification in good standing
- During scheduled work hours, commits full attention to Physician Advisory and execution of outlined tasks
- Other duties as assigned
- Use, protect and disclose patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Understand and comply with Information Security and HIPAA policies and procedures at all times
- Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Qualifications- Board Certified and licensed to practice medicine in the US or 3+ years active clinical experience in the US
- 3+ years working as a Physician Advisor performing Level of care reviews as well as Peer to Peer Reviews
- Basic technical skills with Hospital EMRs 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
- Able to effectively present information, both formal and informal
- Strong analytical skills
- 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
Working Conditions- This role requires availability to provide a minimum of 16 shifts per month. Each shift is 6-8 hours in duration and includes 2 weekend shifts per month.
- Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
- Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
- Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
- Work Environment: The noise level in the work environment is usually minimal.
