Physician Advisor
2 weeks ago
This job listing provides an overview of the main duties and responsibilities of the position. Please note that these responsibilities may be subject to change at the discretion of the organization.
Training, Certification, and Skills- Member of American College of Physician Advisors (ACPA) or Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or Physician Advisor Sub-Specialty Certification by ABQAURP or commitment to pursue such certifications.
- Demonstrated ability to establish rapport with medical staff and hospital leadership.
- Comfortable engaging in difficult conversations.
- Strong computer skills and proficient in EMRs.
- Ability to provide high-quality, cost-effective patient care services.
- Experience in Utilization Management is preferred.
Familiarity with:
- Current medical literature.
- Healthcare reimbursement issues such as medical necessity, coding, and Medicare/Medicaid compliance.
- MCG/InterQual screening criteria.
- Understanding of medical staff structure, policies, and procedures.
- Establish and maintain partnerships with stakeholders to support proper management of patient care activities.
- Assist in medical necessity reviews and length of stay management.
- Provide education on medical necessity and regulations to clinical and non-clinical staff.
- Collaborate with case managers, physicians, and operations teams.
- Review patient medical records for quality and utilization oversight.
- Ensure consistency and quality control in utilization review services.
- Act as a liaison with payers to facilitate approvals and prevent denials.
- Participate in quality improvement initiatives and provide guidance to healthcare teams.
- Support education needs of medical staff regarding documentation and resource utilization.
- Participate in Quality Improvement Initiatives related to documentation and patient placement.
- Coach physicians and new residents on documentation and utilization standards.
- Contribute to UM Committee efforts at the hospital level.
- Engage in ongoing training related to the Physician Advisor role and Utilization Management.
- Identify and support education needs of the medical staff.
Other duties:
- Perform additional duties as assigned, aligned with the PA's competencies.
The Physician Advisor will report to the Vice President of Medical Affairs. Performance evaluation will be based on metrics related to work volume, quality of interaction, utilization process, hospital throughput, and other appropriate performance indicators.
Please be aware of current laws and regulations governing the assigned responsibilities and ensure compliance.
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