Physician - Advisor (Care Management and CDI)

2 months ago


Longview, United States CHRISTUS Health Full time

Description

Roles and Responsibilities Overview
The Physician Advisor-Care Management and Clinical Documentation Improvement (PACM) is a full-time administrative physician role serving Good Shepherd Hospital - Longview and its affiliates through teaching, consulting, and advising both the Care Management Department and the medical staff on matters regarding physician practice patterns, documentation, over- and under-utilization of resources, medical necessity, compliance rules and regulations, collaboration and relationships with payers, and the community. The PACM also ensures physician support and execution for the Care Management and CDI Departments' initiatives by promoting effective and efficient physician documentation to support the patient's Level of Care (LOC), billing status, and appropriateness of Medicare Severity-Diagnosis Related Group (MS-DRG)/DRG assignment. The PACM will submit monthly time records documenting time actually spent in the provision of the responsibilities outlined below.

Professional Qualifications
The Physician Advisor-Care Management and Clinical Documentation Improvement role should be staffed by a physician with the following qualifications:

Licensed physician in state of residence

Certified by the American Board of Quality Assurance and Utilization Review Physicians, Inc (ABQUARP) - preferred

Experienced in clinical practice with understanding of utilization review

Served on or chaired a Utilization Management committee

Demonstrated cost efficient practice

Physician Advisor - Care Management & CDI Duties and Responsibilities

Utilization Management Plan: 20%

In collaboration with the Director of CM, lead the Utilization Review Committee

In collaboration with the Director of CM, monitor key metrics for UM and participate in action steps to achieve targets. Metrics include (but not limited to):

Denial trends, appeals & recoveries

Length of stay- inpatient and observation

Condition Code 44

Physician & Staff Education: 15%

Provide education to physicians and other clinicians related to regulatory requirements, appropriate billing status and utilization of alternate levels of care, community resources, and end of life care.

Work with physicians to facilitate referrals to the continuum of care

Facilitate, mentor, and educate other physicians regarding payer requirements

Provide mentoring/coaching to UR Case Managers to increase knowledge in care progression

Educate physicians on the benefits and importance of a clinical documentation program and how to work with CDI specialists


Care Management: 50%

Participate in daily IDRs takes action to expedite testing and treatment to promote efficient patient care and appropriate LOC

Provides guidance/assistance to the Emergency Department Physicians and CM staff to assure correct LOC designation at intake

Act as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate

Participate in review of long stay patients escalated from Care Management to facilitate the use of the most appropriate LOC

Review cases that indicate a need for issuance of a hospital notice of non-coverage determination. Discuss the case with the attending physician and if additional clinical information is not available, discuss the process for issuance and appeal with the physician.

Document patient care reviews, decisions, and other pertinent information per hospital policy

Possess foundational knowledge of InterQuale criteria

Participate in Care Management Leadership & staff meetings to help identify and progress toward departmental goals

Notify the Care Manager of any conflict of interest in reviewing a particular patient record. Assist with identifying a physician to review such record.

Clinical Documentation Integrity 15%

Provide feedback to physicians in each service on clinical documentation using specific case examples/3M

Recruiter Contact Information:

Lorie Seals

Email: 

lorie.seals@christushealth.org


  • Physician Advisor

    4 weeks ago


    Longview, Texas, United States Christus Health Full time

    Job SummaryWe are seeking a highly skilled Physician Advisor to join our team at Christus Health. As a key member of our Physician Advisory Services team, you will play a critical role in ensuring the quality and efficiency of patient care while promoting responsible stewardship of clinical resources.Key ResponsibilitiesConduct thorough reviews of patient...

  • Physician Advisor

    3 days ago


    Longview, Texas, United States CHRISTUS Health Full time

    About the RoleThe Physician Advisor-Care Management and Clinical Documentation Improvement (PACM) is a key administrative physician role at CHRISTUS Health. This full-time position serves our hospitals and affiliates through teaching, consulting, and advising the Care Management Department and medical staff on matters related to physician practice patterns,...


  • Longview, Texas, United States Christus Health Full time

    Job SummaryThe Emergency Department Care Manager plays a vital role in ensuring the efficient and effective care of patients in the emergency department. This position requires a strong understanding of clinical criteria and the ability to collaborate with multidisciplinary teams to determine the appropriate level of care for patients.Key...


  • Longview, Texas, United States Christus Health Full time

    Job Summary:The Emergency Department (ED) Care Manager plays a vital role in ensuring patients receive the most appropriate level of care. This position collaborates with patients, families, multidisciplinary teams, physicians, community partners, and payers to determine the best course of action. The ED Care Manager has a deep understanding of patient...


  • Longview, Washington, United States Bud Clary Auto Group Full time

    Service Advisor Opportunity at Bud Clary Auto GroupWe are seeking a highly organized and friendly Service Advisor to join our team at Bud Clary Auto Group in Longview. As a Service Advisor, you will play a critical role in ensuring our customers receive exceptional service and support.Key Responsibilities:Schedule service appointments and obtain customer and...


  • Longview, Texas, United States Archway Physician Recruitment Full time

    Emergency Medicine Physician Job OpportunityArchway Physician Recruitment is seeking a skilled Emergency Medicine Physician to join our team in Longview, Texas.About the Role:Provide high-quality patient care in an emergency settingCollaborate with healthcare teams to ensure effective treatment and management of patientsStay up-to-date with the latest...


  • Longview, United States Ulta Beauty Full time

    Ulta Beauty - 3096 N Eastman Rd Ste 105 [Sales Associate / Team Member] As a Beauty Advisor at Ulta Beauty, you'll: Make eye contact, smile, and promptly acknowledge and greet each guest entering the store; Determine each guest need and answer questions concerning products and services; Partner with management to ensure the guest needs are met; Recommend...


  • Longview, Texas, United States SCP Health Full time

    Critical Care/Trauma Physician OpportunitySCP Health is seeking a skilled Critical Care/Trauma Physician to join our team in Longview, Texas.About the RoleWe are looking for a highly qualified physician to provide exceptional patient care in our critical care and trauma unit. As a Critical Care/Trauma Physician, you will be responsible for managing...


  • Longview, Texas, United States Archway Physician Recruitment Full time

    Pulmonology Physician Job OpportunityArchway Physician Recruitment is seeking a skilled Pulmonology Physician to join our team in Longview, Texas.About the Role:Provide high-quality patient care in a dynamic and fast-paced environment.Collaborate with a multidisciplinary team to deliver exceptional patient outcomes.Stay up-to-date with the latest...


  • Longview, Texas, United States Archway Physician Recruitment LLC Full time

    Emergency Medicine Physician Opportunity in Longview, TXWe are seeking an experienced Emergency Medicine physician to join our team at a state-of-the-art freestanding emergency department in Longview, TX.Key Highlights:9-bed facility with advanced equipment, including ultrasound, CT, and radiologyManageable caseload with an annual volume of 6,000...


  • Longview, Texas, United States Archway Physician Recruitment Full time

    Emergency Medicine Physician OpportunityWe are seeking a skilled Emergency Medicine Physician to join our team at a Level III trauma center in TX. This 25-bed emergency department sees an annual volume of 36,000 patients and offers a stable and respected work environment.Key Highlights:Permanent, full-time position with no callExcellent hourly compensation...


  • Longview, Texas, United States Adelphi Medical Staffing, LLC Full time

    Pulmonology-Critical Care Physician Job OpportunityWe are seeking a highly skilled Pulmonology-Critical Care Physician to join our team at Adelphi Medical Staffing, LLC. As a critical care pulmonologist, you will be responsible for providing exceptional patient care and management of complex respiratory and critical care cases.About the RoleProvide...


  • Longview, Washington, United States Bud Clary Auto Full time

    Job DescriptionWe are seeking a skilled Subaru Service Advisor to join our team at Bud Clary Auto Group. As a Service Advisor, you will play a crucial role in ensuring our customers receive exceptional service and support.Key Responsibilities:Schedule service appointments and obtain customer and vehicle data prior to arrival.Provide excellent customer...


  • Longview, Texas, United States Caliber Healthcare Solutions Full time

    Locum Tenens OpportunityCaliber Healthcare Solutions is seeking a Cardiothoracic Surgery MD/DO for a locum tenens opportunity in TX. This assignment requires call coverage and is a short-term position.About the OpportunityThis opportunity is ideal for a physician looking for a flexible and autonomous career path. As a locum tenens provider, you will have the...


  • Longview, Texas, United States Northeast Healthcare Recruitment Full time

    Primary Care Physician OpportunityWe are seeking a highly skilled Primary Care Physician to join our team in Longview, TX. As a Primary Care Physician, you will be responsible for providing exceptional primary care to our patients.What We Offer:Competitive salary with quarterly bonus based on quality metrics6 weeks of PTO, inclusive of vacation, sick time,...


  • Longview, Texas, United States Archway Physician Recruitment LLC Full time

    Emergency Medicine Physician OpportunityWe are seeking a skilled Emergency Medicine Physician to join our team at a Level III trauma center in TX. This is a permanent, full-time position with no call requirements.Key Highlights:Excellent hourly compensationFlexible schedulingAccess to professional development tools and educational resourcesStability of a...


  • Longview, Texas, United States SCP Health Full time

    Join SCP Health as a Critical Care/Trauma PhysicianSCP Health is seeking a skilled Critical Care/Trauma Physician to join our team in Longview, Texas. As a Critical Care/Trauma Physician, you will be responsible for providing high-quality patient care in a fast-paced environment.About the RoleProvide critical care services to patients with life-threatening...

  • Nurse Care Manager

    2 months ago


    Longview, Texas, United States Buckner International Full time

    Job SummaryBuckner International is seeking a skilled Nurse Care Manager to join our team at Westminster Place in Longview, TX. As a key member of our healthcare team, you will be responsible for coordinating resident care management and staff direction to deliver exceptional nursing services.Key ResponsibilitiesCoordinate Resident Care: Ensure that...


  • Longview, Texas, United States Adelphi Medical Staffing, LLC Full time

    Pulmonology-Critical Care Physician Job DescriptionAdelphi Medical Staffing, LLC is seeking a skilled Pulmonology-Critical Care Physician to join our team in Longview, Texas.About the JobThis is an exciting opportunity to work with a reputable healthcare organization and contribute to the delivery of high-quality patient care.ResponsibilitiesProvide expert...


  • Longview, Washington, United States PeaceHealth Full time

    Join Our Team at PeaceHealthWe are seeking a highly skilled and compassionate Primary Care Physician, Nurse Practitioner, or Physician Assistant to join our team at PeaceHealth St. John Medical Center in Longview, Washington.About the RoleThis is an excellent opportunity to make a difference in the lives of our patients and community. As a Primary Care...