Physician Advisor

Job Profile Summary

This role focuses on performing health assessments, running diagnostic tests, prescribing medication and creating treatment plans as well as providing health and wellness education to patients.

In addition, this role focuses on performing the following Physician duties : Diagnoses and treats injuries or illnesses and address health maintenance of patients.

Responsibilities also include examining patients, taking medical histories, prescribing medications and ordering, performing and interpreting diagnostic tests.

A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs.

The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education.

A specialist level role that is a recognized subject matter expert in job area typically obtained through advanced education and work experience.

Typically manages large projects or processes with limited oversight from manager, coaches, reviews and delegates work to lower level professionals, resolving difficult and often complex problems.

Job Overview

The Physician Advisor is a critical role that ensures physician support for high quality, compliant and efficient workflows related to utilization review, clinical documentation, and revenue cycle coding and billing throughput.

The role provides clinical direction and leadership to the organization, increasing the ability to produce optimal patient outcomes;

ensuring quality, legal, ethical, regulatory, and reimbursement best practices. The position intends to further connect physicians with the end to end processes required for compliant and optimal reimbursement of care and to identify opportunities for increased efficiency and support for the required workflows.

Acts as a peer to clinical staff and consultant to case management, clinical documentation specialists, and hospital administration.

The physician advisor is at the intersection of monitoring and intervening when practice patterns create disparities between pathway standards, severity of illness, patient and family rights, teamwork, and other issues regarding the stewardship of resources for patients, special populations, and the organization as a whole.

Job Description

Minimum Qualifications :

1. Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).

2. Board Certified in applicable specialty

3. Hospital approved credentials (medical license, clinical privileges).

4. Three (3) or more years of clinical practice, unless active certification as a physician advisor

Preferred Qualifications :

1.Prior experience in utilization review / secondary review desired

Duties and Responsibilities : The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.

Other duties and responsibilities may be assigned.

1.Works with the lead(er) to set agendas, priorities, and review / revise objective and subjective UM / CM targets around cost, quality, and patient satisfaction.

2.Actively participates in the Utilization Review Committee and other committees as directed.

3.Supports the planning, development, and presenting of education about utilization / case management topics, healthcare trends, post-acute continuum capabilities, clinical documentation issues and other assigned subjects.

4.Provides timely and effective consultation to case management / utilization review team members, including assessment of clinical / utilization review plans, development of recommendations, and supporting necessary follow up.

Facilitates communication between case management, UM team members, the clinical team, and other key people involved in caring for the patients whose cases have been referred for evaluation.

5.Actively supports assigned activities related to payer denials, peer-to-peer discussions, appeal processes, level of care determinations, admission decisions, patient level of care transitions, and other situations as requested.

6.Serves as an expert resource on quality, ethical, regulatory, and / or financial topics related to patient care, utilization management / review, case management, and revenue cycle functions.

7.Provides clinical support to the utilization review and clinical documentation specialist for resolution of challenging cases, including the facilitation of communication with the clinical team.

8.Provides clinical documentation improvement education and feedback to medical staff (meetings, newsletters, memos, etc.

Educates physicians and clinicians on the link between documentation and coding guidelines, including impacts on severity of illness, acuity, risk of mortality, readmissions, and reimbursement.

9.Provides utilization review education and feedback to hospital medical staff on level of care determinations, regulatory requirements, and appropriate documentation on the plan of care, while applying evidence based clinical decision support tools for status determination.

10.Actively involved in the orientation of new clinical staff on the topics of utilization review, clinical documentation improvement, and other topics as assigned.

11.Meets with clinical documentation improvement staff regularly to review selected medical records concurrently or retrospectively to assist in the development of approved quality indicators and clinically appropriate and compliant provider documentation queries.

12.Works with leaders to monitor appropriate utilization management and clinical documentation improvement performance and quality metrics

13.Participates in hospital wide complex care, daily discharge, observation, and complex length of stay rounds as requested / assigned.

14.Identifies and communicates quality improvement opportunities to leaders and participates in development of solutions and ensuring follow through.

15.Consults with experts in areas outside of individual practice expertise to support utilization management, care management, and clinical care quality improvement.

16.Embraces and engages in self-directed study and advancement of expertise as a physician advisor subject matter expert.

17.Recognizes and complies with legal regulatory, accrediting and procedural requirements related to area of responsibility.

18.Protects patient and team member privacy and only accesses patient and / or team member related information as needed to perform job duties.

Physical Requirements :

1.Generally, day hours with flexibility to meet the demands of the position.

2.Prolonged, extensive, or considerable standing / walking.

3.Lifts, positions, pushes and or transfer patients and equipment.

4.Considerable reaching, stooping, bending, kneeling, crouching.

5.Frequent exposure to hazardous chemicals, sick patients, bodily substances, noise and possible exposure to radiation, lasers, electric shock etc.

6.Regularly exposed to the risk of bloodborne diseases and other transmissible infections.

7.Contact with patients under a wide variety of circumstances including interhospital transport in emergency vehicles, ambulances, helicopters and fixed wing aircraft.

8.Subject to varying and unpredictable situations.

9.Handle emergency crisis situations.

10.May have contact with hazardous materials

Skills & Abilities :

1.Requires excellent communication skills and the ability to interact at all levels of the organization.

2. Epic, Outlook, and Microsoft Office are a necessary pre-requisite skill set for this position.

3. Knowledge of CMS regulations, as applicable to the work, is required.

4. Ability to self-learn, seek out knowledge assets that apply to the work, and pursue core competencies are a key attribute of this position