Clinical Advisor for Care Management

7 days ago


Irving, Texas, United States CHRISTUS Health Full time

Position Overview

Role Summary:

The Clinical Advisor is a full-time administrative role dedicated to supporting CHRISTUS Health and its affiliates through education, consultation, and guidance to both the Care Management Department and the medical staff. This position focuses on physician practice patterns, documentation accuracy, resource utilization, medical necessity, compliance with regulations, and fostering relationships with payers and the community.

The Clinical Advisor will play a crucial role in ensuring physician engagement and support for the initiatives of the Care Management and Clinical Documentation Improvement (CDI) Departments. This includes promoting effective physician documentation to substantiate the patient's Level of Care (LOC), billing status, and the appropriateness of Medicare Severity-Diagnosis Related Group (MS-DRG)/DRG assignments. Monthly time records will be submitted to document the time dedicated to the responsibilities outlined below. This position operates Monday through Friday, with no on-call duties.

Qualifications:

The Clinical Advisor for Care Management and Clinical Documentation Improvement should possess the following qualifications:

  • A minimum of 5 years of clinical experience
  • Active medical license in the state of residence
  • Board certification in a relevant clinical specialty
  • Preferred certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc (ABQUARP)
  • Experience in clinical practice with a solid understanding of utilization review
  • Previous involvement in or leadership of a Utilization Management Committee
  • Demonstrated practice of cost-efficient healthcare delivery

Key Responsibilities:

Utilization Management Leadership: 20%

Collaborate with the Director of Care Management to lead the Utilization Review Committee and monitor key performance metrics for utilization management. This includes:

  • Analysis of denial trends, appeals, and recoveries
  • Monitoring length of stay for inpatient and observation cases
  • Oversight of Condition Code 44

Education and Training: 15%

Provide educational sessions for physicians and clinical staff on regulatory requirements, appropriate billing practices, utilization of alternative care levels, community resources, and end-of-life care. Responsibilities include:

  • Facilitating referrals to the continuum of care
  • Mentoring physicians on payer requirements
  • Coaching Utilization Review Case Managers to enhance their knowledge in care progression
  • Educating physicians on the significance of clinical documentation programs and collaboration with CDI specialists

Care Management Involvement: 50%

Engage in daily interdisciplinary rounds to expedite testing and treatment, ensuring appropriate patient care and LOC designation. Duties include:

  • Providing guidance to Emergency Department physicians and Care Management staff
  • Acting as a liaison with payers to facilitate approvals and mitigate denials
  • Reviewing long-stay patient cases escalated from Care Management
  • Documenting patient care reviews and decisions in accordance with hospital policy
  • Possessing foundational knowledge of InterQual and MCG criteria
  • Participating in Care Management leadership meetings to identify and progress toward departmental goals
  • Notifying Care Managers of any conflicts of interest in patient record reviews

Clinical Documentation Integrity: 15%

Provide constructive feedback to physicians regarding clinical documentation using specific case examples.

Benefits:

Enjoy a balanced professional and personal lifestyle with competitive compensation and benefits, including relocation assistance.

Community Overview:

Experience a vibrant community with year-round outdoor activities such as golfing, hunting, fishing, camping, hiking, and boating, along with access to excellent public and private schools.



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