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Posted: 21-Jan-25
Location: Texarkana, Texas
Categories:
Internal Number: 242049
Roles and Responsibilities Overview
The Physician Advisor is a full-time administrative physician role serving CHRISTUS St. Michael hospital and its affiliates through teaching, consulting, and advising both the Care Management Department and the medical staff on matters regarding physician practice patterns, documentation, over- and under-utilization of resources, medical necessity, compliance rules and regulations, collaboration and relationships with payers, and the community. The PA also ensures physician support and execution for the Care Management and CDI Departments' initiatives by promoting effective and efficient physician documentation to support the patient's Level of Care (LOC), billing status, and appropriateness of Medicare Severity-Diagnosis Related Group (MS-DRG)/DRG assignment. The PA will submit monthly time records documenting time actually spent in the provision of the responsibilities outlined below. M-F, no call responsibilities!
Reporting Relationship
The PA reports directly to the Chief Medical Officer of St. Michael hospital- Texarkana
Professional Qualifications
The Physician Advisor-Care Management and Clinical Documentation Improvement role should be staffed by a physician with the following qualifications:
· 5 years of clinical experience
· Licensed physician in state of residence
· Board certified in a clinical specialty
· Certified by the American Board of Quality Assurance and Utilization Review Physicians, Inc (ABQUARP) - preferred
· Experienced in clinical practice with an understanding of utilization review
· ·Served on or chaired an Utilization Management Committee
· ·Demonstrated cost-efficient practice
·
Physician Advisor - Care Management & CDI Duties and Responsibilities
Utilization Management Plan: 20%
?In collaboration with the Director of CM, lead the Utilization Review Committee
?Conduct secondary status reviews for appropriate level of care determination
?Conduct peer-to-peer consults with the payor medical directors for the denied cases, to resolve medical necessity issues prior to claims submission.
?In collaboration with the CMO and Director of CM, monitor key metrics for UM and participate in action steps to achieve 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 to physicians and other clinicians related to regulatory requirements, appropriate billing status and utilization of alternate levels of care, community resources, and end of life care.
?Work with physicians to facilitate referrals to the continuum of care
?Facilitate, mentor, and educate other physicians regarding payer requirements
?Provide mentoring/coaching to UR Case Managers to increase knowledge in care progression
?Educate physicians on the benefits and importance of a clinical documentation program and how to work with CDI specialists
Care Management: 50%
?Participate in daily IDRs takes action to expedite testing and treatment to promote efficient patient care and appropriate LOC
?Provides guidance/assistance to the Emergency Department Physicians and CM staff to ensure correct LOC designation at intake
?Act as a liaison with payers to facilitate approvals and prevent denials or carved-out days when appropriate
?Participate in review of long-stay patients escalated from Care Management to facilitate the use of the most appropriate LOC
?Review cases that indicate a need for issuance of a hospital notice of non-coverage determination. Discuss the case with the attending physician and if additional clinical information is not available, discuss the process for issuance and appeal with the physician.
?Document patient care reviews, decisions, and other pertinent information per hospital policy
?Possess foundational knowledge of InterQual and MCG criteria
?Participate in Care Management Leadership & staff meetings to help identify and progress toward departmental goals
?Notify the Care Manager of any conflict of interest in reviewing a particular patient record. Assist with identifying a physician to review such record.
Clinical Documentation Integrity 15%
?Provide feedback to physicians in each service on clinical documentation using specific case examples/3M
Highlights/ Benefits:
· Balanced professional and personal lifestyle
· Competitive compensation and benefits
· No state income tax
· Relocation assistance
Community Description:
· Easy drive to Dallas
· Enjoy the lush green countryside, pine tree-covered hills and lakes.
· Year-round outdoor activities include golfing, hunting, fishing, camping, hiking, and boating.
· Excellent public and private schools
Recruiter Contact Information:
Recruiter Contact Information:
Liz Flippo
Email:
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