Physician Advisor
Company: Christus Health
Location: Alexandria
Posted on: October 17, 2024
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Job Description:
Description
Summary:
The Physician Advisor is a full-time administrative physician role
serving CHRISTUS St. Frances Cabrini 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!
Requirements:
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
---In collaboration with the 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
- 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.
- Excellent public and private schools
Recruiter Contact Information:
Lynda Corotan
Email:
lynda. corotan@christushealth. org
Work Type:
Full Time
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Keywords: Christus Health, Monroe , Physician Advisor, Healthcare , Alexandria, Louisiana
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