Description
Summary :
The Physician Advisor is a full-time administrativephysician role serving CHRISTUS St. Frances Cabrini Hospital, andits affiliates through teaching, consulting, and advising both theCare Management Department and the medical staff on mattersregarding physician practice patterns, documentation, over- andunder-utilization of resources, medical necessity, compliance rulesand regulations, collaboration and relationships with payers, andthe community.
The PA also ensures physician support and executionfor the Care Management and CDI Departments' initiatives bypromoting effective and efficient physician documentation tosupport the patient's Level of Care (LOC), billing status, andappropriateness of Medicare Severity-Diagnosis Related Group(MS-DRG) / DRG assignment.
The PA will submit monthly time recordsdocumenting time actually spent in the provision of theresponsibilities outlined below.
M-F, no callresponsibilities!
Requirements :
The Physician Advisor-Care Management and ClinicalDocumentation Improvement role should be staffed by a physicianwith the following qualifications :
- 5 years ofclinical experience
- Licensed physician instate of residence
- Board certified in aclinical specialty
- Certified by theAmerican Board of Quality Assurance and Utilization ReviewPhysicians, Inc (ABQUARP) - preferred
- Experienced in clinical practice with an understanding ofutilization review
- Served on or chaired anUtilization Management Committee
- Demonstrated cost-efficient practice
Physician Advisor - Care Management& CDI Duties and Responsibilities
Utilization Management Plan : 20%
- In collaboration withthe Director of CM, lead the Utilization Review Committee
- In collaboration with the Director of CM,monitor key metrics for UM and participate in action steps toachieve targets. Metrics include (but not limited to) :
- Denial trends, appeals & recoveries
- Length of stay- inpatient and observation
- Condition Code 44
Physician & Staff Education : 15%
- Provide education tophysicians and other clinicians related to regulatory requirements,appropriate billing status and utilization of alternate levels ofcare, community resources, and end of life care.
- Work with physicians to facilitate referrals to thecontinuum of care
- Facilitate, mentor, andeducate other physicians regarding payer requirements
- Provide mentoring / coaching to UR Case Managers toincrease knowledge in care progression
- Educatephysicians on the benefits and importance of a clinicaldocumentation program and how to work with CDI specialists
Care Management : 50%
- Participate in dailyIDRs takes action to expedite testing and treatment to promoteefficient patient care and appropriate LOC
- Provides guidance / assistance to the Emergency DepartmentPhysicians and CM staff to ensure correct LOC designation at intake
- Act as a liaison with payers to facilitateapprovals and prevent denials or carved-out days when appropriate
- Participate in review of long-stay patientsescalated from Care Management to facilitate the use of the mostappropriate LOC
- Review cases that indicate aneed for issuance of a hospital notice of non-coveragedetermination. Discuss the case with the attending physician and ifadditional clinical information is not available, discuss theprocess for issuance and appeal with the physician.
- Document patient care reviews, decisions, and otherpertinent information per hospital policy
- Possess foundational knowledge of InterQual and MCGcriteria
- Participate in Care ManagementLeadership & staff meetings to help identify and progresstoward departmental goals
- Notify the CareManager of any conflict of interest in reviewing a particularpatient record. Assist with identifying a physician to review suchrecord.
ClinicalDocumentation Integrity 15%
Provide feedback to physicians in each service onclinical documentation using specific case examples / 3M
Highlights / Benefits :
- Balanced professional and personal lifestyle
- Competitive compensation and benefits
- Relocation assistance
Community Description :
- Easy drive to New Orleans / Baton Rouge area
- Easy access to local airport
- Year-round outdoor activities include golfing, hunting, fishing,camping, hiking, and boating.
- Excellentpublic and private schools
RecruiterContact Information :
LyndaCorotan
Email :
lynda. corotan@christushealth. org
WorkType : FullTime
FullTime
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