Physician Advisor- CDI

Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
• Board Certified in applicable specialty
• Hospital approved credentials (medical license, clinical privileges).
• Three (3) or more years of clinical practice, unless active certification as a physician advisor
• 1.Prior experience in utilization review/secondary review desired
• Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.
• 1.Works with the lead(er) to set agendas, priorities, and review/revise objective and subjective UM/CM targets around cost, quality, and patient satisfaction.
• 2.Actively participates in the Utilization Review Committee and other committees as directed.
• 3.Supports the planning, development, and presenting of education about utilization/case management topics, healthcare trends, post-acute continuum capabilities, clinical documentation issues and other assigned subjects.
• 5.Actively supports assigned activities related to payer denials, peer-to-peer discussions, appeal processes, level of care determinations, admission decisions, patient level of care transitions, and other situations as requested.
• 6.Serves as an expert resource on quality, ethical, regulatory, and/or financial topics related to patient care, utilization management/review, case management, and revenue cycle functions.
• 7.Provides clinical support to the utilization review and clinical documentation specialist for resolution of challenging cases, including the facilitation of communication with the clinical team.
• 9.Provides utilization review education and feedback to hospital medical staff on level of care determinations, regulatory requirements, and appropriate docum

Benefits

Additional Information

Job Profile Summary This role focuses on performing health assessments, running diagnostic tests, prescribing medication and creating treatment plans as well as providing health and wellness education to patients. In addition, this role focuses on performing the following Physician duties: Diagnoses and treats injuries or illnesses and address health maintenance of patients. Responsibilities also include examining patients, taking medical histories, prescribing medications and ordering, performing and interpreting diagnostic tests. A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs. The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education. A specialist level role that is a recognized subject matter expert in job area typically obtained through advanced education and work experience. Typically manages large projects or processes with limited oversight from manager, coaches, reviews and delegates work to lower level professionals, resolving difficult and often complex problems. Job Overview The Physician Advisor is a critical role that ensures physician support for high quality, compliant and efficient workflows related to utilization review, clinical documentation, and revenue cycle coding and billing throughput. The role provides clinical direction and leadership to the organization, increasing the ability to produce optimal patient outcomes; ensuring quality, legal, ethical, regulatory, and reimbursement best practices. The position intends to further connect physicians with the end - to - end processes required for compliant and optimal reimbursement of care and to identify opportunities for increased efficiency and support for the required workflows. Acts as a peer to clinical staff and consultant to case management, clinical documentation specialists, and hospital administration. The physician advisor is at the intersection of monitoring and intervening when practice patterns create disparities between pathway standards, severity of illness, patient and family rights, teamwork, and other issues regarding the stewardship of resources for patients, special populations, and the organization as a whole. Job Description

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Company Intel

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