Peer To Peer Physician Advisor

Job Purpose

The 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, insuring 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

• 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
• Achieve performance goals as outlined in employment agreement
• Facilitate, mentor, and educate other physicians regarding payer requirements
• Upholds the organization’s values of team work and professionalism and applies Code of Conduct standards to all members of the healthcare team
• Demonstrates behavior that supports the organization’s mission. Participates in required orientation and training related to the Physician Advisor role.
• 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.
• 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.
• Demonstrates commitment to meeting/exceeding strategic initiatives of organization.
• Attends all meetings as requested by PAOC leadership
• Maintains confidentiality of patient care and business matters
• 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.
• Participate in the peer review process as may be necessary or requested.
• Meets productivity standards within established time requirements. Work product and performance meets or exceeds quality standards.
• Maintain medical licensure and board certification in good standing.
• 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.
• Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment

Qualifications

• Member of the American College of Physician Advisors (ACPA) preferred.
• Familiarity with MCG/InterQual placement status criteria is preferred.
• Basic technical skills with Hospital EMRs and Microsoft Office and Teams a must
• 3+ years working as a Physician Advisor performing case reviews
• 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.
• Board Certified and licensed to practice medicine in the US or 3+ years active clinical experience in the US
• 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.
• Hold and maintain an unrestricted medical license and Board Certification

Other Skills or Special Abilities

• Excellent customer service and interpersonal skills and the utmost professionalism is required
• Able to effectively present information, both formal and informal.
• Strong organizational skills and ability to set priorities and multi-task, demonstrates flexibility, teamwork, and is accustomed to change in the healthcare environment.
• Demonstrates ability to drive results and produce outcomes
• Strong written and verbal communications skills with all levels of internal and external customers.
• Strong analytical skills.

Working Conditions

• 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.
• Work Environment: The noise level in the work environment is usually minimal.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.