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Physician Advisor, Case Management, Full Time, Days, Jackson South and Jackson West Medical Center
4 months ago
Miami, FL Full-Time Case Management Jackson South and Jackson West Medical Center
Summary
The Physician Advisor (PA) serves as a clinical resource to the medical staff and CM/SW by providing identification, facilitation, and resolution of utilization issues. The PA role reports to the Chief Medical Officer, Chief Utilization Officer, or his/her designee. The Physician Advisor addresses the following issues: level of care, payer peer to peer correspondence, documentation, compliance, discharge planning, and hospital reimbursement and quality issues. Additionally, the Physician Advisor role ensures proper status determination with support of CM/SW (case manager/social worker. Additionally, Physician Advisors promote understanding and cooperation between the medical staff through communication, collaboration, and education.
Responsibilities
Acute Inpatient/Care Management Functions: Physician Advisors are expected to round to various units with the unit nurse managers, case managers, and social workers to bridge with the various medical teams to ensure appropriate level of care determination, improved documentation, appropriate utilization, and discharge planning. Participates in review of long-stay patients, in conjunction with Care Management Leadership, Care Management Team and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care. Supports multidisciplinary team meetings and individual family meets as part of discharge planning. Provides education to physicians and other clinicians regarding optimal use of the ICU and other limited resources. Documents patient care reviews, decisions, and other pertinent information as requested. Understands and uses InterQual, MCG and other appropriate criteria. Identifies patients who are appropriate for transfer to LTACH, SNF or other facilities and works with physicians to facilitate referrals as needed. Works with Care Management and interdisciplinary teams to ensure appropriate continuity of care and to reduce readmissions. Communication with payors to justify admissions and overturn denials as appropriate, including peer to peer/doc to doc communication with payors. Physician Support and Education: The PA acts as a resource for attending physicians, residents, and providers to support the appropriate admission, continued stay, and utilization of resources for their patients. Provides feedback and education to other physicians and providers regarding payer requirements, level of care, length of stay, appropriate utilization, community resources, end of life care, quality improvement and other necessary information. Hospital Process Improvement: Promotes and participates in hospital quality and performance improvement programs and supports engagement of physicians and other providers in these activities. Clinical Documentation Support: Serves as liaison between the CDI professional, HIM, and other physicians and providers to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity, and risk of mortality, in addition to DRG assignment. Educates physicians and providers about clinical documentation to support admission, ICD coding guidelines (e.g., co-morbid conditions, outpatient vs. inpatient) and clinical terminology, DRG assignments, E&M coding, HCC coding, and other documentation topics which may include their individual patient records. Educates specific medical staff departments (e.g., Internal Medicine, Surgery, Family Practice, etc.) regarding these documentation issues and their link to quality and performance measures. Role models behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise). Performs all other related job duties as assigned.
Experience
The ideal candidate has experience as a hospitalist, physician advisor, or experience with utilization review or CDI. Knowledge of, and experience with InterQual, MCG, and major payor classes is desirable.
Education
MD or DO degree (US or FMG) is required.
Skill
Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written form. Ability to handle difficult and stressful situations with critical thinking and professional composure. Ability to understand and follow instructions. Ability to exercise sound and independent judgment. Knowledge and skill in use of job appropriate technology and software applications.
Credentials
Active Florida medical license or house physician license (or eligibility) is required. ABQAURP certification is preferred.
Working Conditions
Physical Requirements - Function may require frequent standing or walking. Must be able to lift or carry objects weighing up to 20 pounds. Jobs in this group are required to have close visual acuity to perform activities such as: extended use of computers, preparing and analyzing data and analytics, and other components of a typical office environment. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).
Environmental Conditions - Jobs in this group are required to function in a fast paced environment with occasional high pressure or emergent and stressful situations. Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the public. Function is subject to inside environmental conditions, with occasional outdoor exposures. Possible exposure to various environments such as: communicable diseases, toxic substances, medicinal preparations and other conditions common to a hospital and medical office environment. May wear Personal Protective Equipment (PPE) such as gloves or a mask when exposed to hospital environment outside of office. Reasonable accommodations can be made to enable people with disabilities to perform the described essential functions. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).
