Physician Advisor - Fully Remote

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, 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
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Qualifications

Working Conditions

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.

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