Physician Advisor, Care Progression

Sutter Health • Modesto, CA

106d • $110 - $176

About The Position

The Physician Advisor (PA) is a key member of the hospital's leadership team charged with meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial management and compliance with governmental regulations and conditions of participation and commercial insurance contracts. The PA is responsible for establishing, maintaining and strengthening the relationship with System Enterprise and the hospital to appropriately optimize the use of Sutter Health Internal Physician Advisor Services (IPAS). The physician Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to develop and implement methods and strategies to optimize the use of hospital services. This includes care management processes that ensure patients are in the appropriate level of care with supporting documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on cases referred by UM/CM staff and or other healthcare professionals to meet regulatory requirements in accordance with the hospital objectives for assuring quality patient care and effective, efficient utilization of health care services. The PA meets with care management, UM staff and health care team members and medical directors of third-party payers to discuss the needs of patient's and alternative levels of care. The PA acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources. The PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations. The PA will act as a liaison between the CDI (Clinical Documentation Improvement) professional, HIM (Health Information Management), and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk for mortality, in addition to Direct Report Groups (DRG) assignment.

Requirements

• Doctorate: Graduate of an accredited medical school.
• MD-Doctor of Medicine or DO-Doctor of Osteopathy.
• Unrestricted medical license in state of residence.
• 3 years of recent relevant experience.
• Excellent interpersonal communication and negotiation skills.
• Broad knowledge of health care delivery and case management.
• Comprehensive knowledge of Utilization Review and levels of care.
• Awareness of healthcare reimbursement systems.
• Proficient knowledge of coding and DRG assignment process preferred.
• Ability to work independently and exercise sound judgment.

Nice To Haves

• Experience in post-acute levels of care such as Home Health and Hospice.
• Demonstrated commitment to service excellence.
• Excellent time management skills.
• Intermediate computer skills.
• Ability to promote teamwork.

Responsibilities

• Develop expertise on physician practice patterns and resource utilization.
• Establish and maintain relationships with System Enterprise and the hospital.
• Work closely with medical staff and utilization management personnel.
• Implement methods and strategies to optimize hospital services.
• Conduct clinical reviews on cases referred by UM/CM staff.
• Meet with care management and UM staff to discuss patient needs.
• Act as a consultant for attending physicians on hospitalization decisions.
• Facilitate accurate documentation for coding and clinical data.

Benefits

• Comprehensive benefits package.
• Pay range of $110.47 to $176.76 per hour.

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Industry: Nursing and Residential Care Facilities
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees