Physician Advisor

A Brief Overview

The Physician Advisor works closely with the medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided.
What You Will Do

• Review medical records of patients identified as requested in order to perform quality and utilization oversight
• Perform medical necessity reviews including initial level of care, secondary reviews, and continued stay reviews
• Provide regular feedback to physicians and all other stake holders regarding level of care, length of stay, and potential quality issues
• Understand and use MCG/InterQual and other appropriate criteria. Document response to case management referrals. Support Case Management in a data-driven approach
• Consult regarding billing for the technical component of the services rendered, including initial billings, follow-up reports, and appeals in cases of retrospective denials
• Assist with any regulatory audits, investigations, surveys, or other reviews
• Ensure consistency of utilization review services, quality control, and patient safety
• Participate in review of long stay patients, in conjunction with the Care Management team and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care
• Provide guidance to ED physicians and ED Case Management regarding status issues and alternatives to acute care when acute care is not warranted
• Work with Care Management and an interdisciplinary team to insure appropriate continuity of care
• Participate in all organizational efforts to reduce inappropriate readmissions
• Educate physicians and other clinicians regarding regulatory requirements, appropriate utilization of hospital services, community resources, alternative levels of care, readmissions, clinical documentation improvement and care standards as may be appropriate.
• Identify denial trends and work with the medical staff and hospital administration to make improvements.
• Identify & resolve quality, safety, patient satisfaction, and efficiency issues leading to sub-optimal care.
• Develop the skills for screening for medical necessity, ensuring the appropriate level of care and properly crafting clinical queries using established guidelines. Discuss how to recognize when a clinical query is needed with members of the CDI team.
• Provide strategies to minimize risk and reduce provider liability or loss of inpatient revenue.
• Build and expand upon proven strategies that contribute to the development and implementation successes of clinical documentation improvement.
• Effectively communicate physician teaching points for immediate and future clinical case studies.
• Work with the IT to ensure the system appropriately supports the physician's ability to provide best practice medicine by creating logical processes and providing the necessary order sets and practice guidelines.
• Participate as part of the physician advisory council to assist with clinical decisions for the EHR.
• Tract and report monthly performance metrics to key stakeholders.

Additional Responsibilities

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Qualifications:
Education

• Master's Degree (Required)

Knowledge, Skills, & Abilities

• Possesses a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, patient safety, case management and hospital operations. (Required proficiency)
• Strong computer skills and working knowledge of the EMR. (Required proficiency)
• Familiarity with MCG/Interqual placement status criteria. (Preferred proficiency)
• Ability to build rapport with medical staff and hospital leadership to obtain the buy-in and collaboration necessary to achieve desired outcomes. (Required proficiency)
• Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable. (Required proficiency)

Licenses and Certifications

• Member of the American College of Physician Advisors (ACPA) (Preferred)

Physical Demands

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely 20 lbs
• Carrying Rarely 20 lbs
• Pushing Rarely 20 lbs
• Pulling Rarely 20 lbs
• Climbing Rarely 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently

Travel Requirements

• 10%