Clinical Advisor

Position Summary

The Clinical Advisor is responsible for conducting comprehensive evaluations of various case types with a focus on ensuring adherence to regulatory standards. This role involves collaboration with the medical leadership and staff, including resident physicians, to enhance the utilization of hospital resources effectively. The Clinical Advisor identifies opportunities to improve patient care efficiency, including optimizing hospital stay durations and resource management, while ensuring compliance with documentation and coding standards.

Key Responsibilities

• Respond promptly to inquiries from the Case Management department regarding clinical reviews for medical necessity.
• Provide expert consultation to healthcare providers on complex clinical matters, including justifications for continued patient care and utilization management.
• Develop a thorough understanding of established criteria such as MCG/InterQual and apply clinical judgment based on patient-specific factors.
• Accountable for achieving desired outcomes in case management and supporting the medical team in patient care progression.
• Advise on improving health record documentation to enhance accuracy in ICD code assignment and DRG classification.
• Engage in ongoing professional development related to the Clinical Advisor role, focusing on Utilization Management and Care Management.
• Meet established productivity and quality benchmarks within designated timeframes.
• Maintain confidentiality regarding patient information and organizational matters.
• Exhibit behaviors that align with the organization's mission and values, participating in required training and orientation.
• Facilitate education for other physicians on payer requirements and best practices.
• Attend necessary meetings as directed by leadership.
• Participate in peer review processes as needed.
• Maintain active medical licensure and board certification.
• Devote full attention to the responsibilities of the Clinical Advisor during scheduled hours.
• Ensure compliance with HIPAA standards regarding patient health information.

Qualifications

• Board Certified and licensed to practice medicine in the United States or possess 3+ years of active clinical experience in the U.S.
• A minimum of 3 years of experience as a Clinical Advisor, focusing on Level of Care and Peer-to-Peer Reviews.
• Proficient in using Hospital EMRs, Microsoft Office, and Teams.
• Hold and maintain an unrestricted medical license and Board Certification.
• Demonstrate knowledge and experience in utilization management, quality improvement, and patient safety.
• Familiarity with hospital organization and case management operations is essential.
• Preferred membership in the American College of Physician Advisors (ACPA).
• Strong customer service and interpersonal skills are required.
• Excellent verbal and written communication skills across all levels of the organization.
• Ability to prioritize tasks and manage multiple responsibilities effectively.
• Demonstrated initiative and problem-solving skills.

Work Environment

• This position requires availability for a minimum of 16 shifts per month, with each shift lasting 6-8 hours, including weekend coverage.
• Physical demands include mobility within the work area and the ability to operate office equipment.
• Mental demands require the ability to follow directions, collaborate, and manage stress effectively.
• The work environment typically maintains a low noise level.

Med-Metrix is committed to providing equal employment opportunities and does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by law.