Physician Advisor 7 on 7 off

Brundage Medical Group LLC•Pinellas Park, FL

About The Position

The Physician Advisor (PA) drives quality performance across the organization by working with hospital physicians, utilization management, case management, clinical documentation improvement (CDI), denials, and quality staff. The PA reviews cases to support compliance, accurate clinical documentation, and appropriate use of healthcare services, and provides education and expertise to hospital personnel and medical staff as needed. The PA advises attending physicians on patient status, resource utilization, continued hospitalization, compliance concerns, and quality and complication tracking and reporting. The role also works with third-party payer medical directors on medical necessity, resource utilization, and appropriate level of care. The position includes utilization management and denials management responsibilities. The posting seeks experienced Physician Advisors and states that part-time inquiries are not accepted.

Requirements

MD or DO.
Current, unrestricted medical license in the state of residence.
1–3 years of Physician Advisor experience and clinical experience in a hospital-based setting.
Demonstrated ability to build rapport with medical staff and hospital leadership.
Strong computer skills and working knowledge of electronic medical records (EMRs).
Strong interpersonal skills.
Excellent written and verbal communication skills.
Ability to work independently.
Ability to build relationships with key hospital team members.

Nice To Haves

Expertise in Utilization Management.
Board certified or board eligible.
CCDS or CDIP.
CCS.
CHCQM certification (ABQAURP).

Responsibilities

Review medical records of patients identified by the utilization management team or requested by the healthcare team.
Perform status determinations, including second-level and continued-stay reviews for traditional Medicare patients and other payors.
Review Code 44 cases.
Assist with length-of-stay management.
Work with case management and the interdisciplinary team to ensure continuity of care and reduce readmissions.
Communicate important information and provide education to medical staff through secure email, secure texting applications, phone calls, and face-to-face interactions.
Serve as a liaison between Utilization Management/Case Management and providers to collaborate on appropriate plans of care.
Review and suggest improvements related to resource allocation.
Optimize coordination-of-care processes.
Guide emergency department physicians and the UM/CM team regarding alternatives to acute care.
Review denials and author appeal letters as needed.
Conduct peer-to-peer reviews with payors.
Liaise with payors to facilitate approvals and prevent denials or carved-out days when appropriate.
Perform other duties as assigned.