Physician Advisor

Tenet Healthcare Corporation • Delray Beach, FL

7d • Onsite

About The Position

The Physician Advisor (PA) has responsibility for providing medical staff leadership to the Utilization Management Committee (UMC) and functions of the Case Management (CM) and Health Information Management (HIM)/Clinical Documentation Improvement Departments. The PA leads and promotes processes for patients to receive medically necessary and high quality care throughout the continuum of care. The PA also assists in reducing the financial risks associated with denials that are due to providing medically unnecessary or preventable services and extended length of stays. Additionally, the Physician Advisor provides ongoing education and in-service instruction programs for the Hospital's medical staff (including residents and fellows in academic medical centers), nursing and ancillary personnel related to coding/clinical documentation improvement, compliance, and utilization management and quality issues. Further, the PA conducts and documents reviews and for cost and length of stay (LOS) outliers as referred by the non-physician reviewers. He/she conducts medical necessity reviews for cases not referred to an outsourced physician advisor company.

Requirements

• Medical staff leadership
• Understanding of Case Management (CM) and Health Information Management (HIM)/Clinical Documentation Improvement Departments.
• Knowledge of processes for medically necessary and high quality patient care.
• Ability to reduce financial risks associated with denials.
• Experience in providing education and in-service instruction programs.
• Familiarity with coding/clinical documentation improvement, compliance, and utilization management and quality issues.
• Experience in conducting and documenting reviews for cost and length of stay (LOS) outliers.
• Ability to conduct medical necessity reviews.

Responsibilities

• Providing medical staff leadership to the Utilization Management Committee (UMC) and functions of the Case Management (CM) and Health Information Management (HIM)/Clinical Documentation Improvement Departments.
• Leading and promoting processes for patients to receive medically necessary and high quality care throughout the continuum of care.
• Assisting in reducing the financial risks associated with denials that are due to providing medically unnecessary or preventable services and extended length of stays.
• Providing ongoing education and in-service instruction programs for the Hospital's medical staff (including residents and fellows in academic medical centers), nursing and ancillary personnel related to coding/clinical documentation improvement, compliance, and utilization management and quality issues.
• Conducting and documenting reviews for cost and length of stay (LOS) outliers as referred by the non-physician reviewers.
• Conducting medical necessity reviews for cases not referred to an outsourced physician advisor company.

Benefits

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program
• Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed