Physician Advisor

This is a fully remote position, open to applicants in Illinois.

📋 Description

• The Physician Advisor conducts comprehensive case reviews across all categories with expertise and diligence to ensure maximum compliance.

• The Physician Advisor collaborates closely with the Client’s medical staff leadership, the full medical team, including resident physicians, various resource management sectors, case management, social services, discharge planning, and utilization management to propose strategies that enhance hospital service utilization for all patients.

• This role involves pinpointing opportunities to optimize hospital stay durations and resource management efficiency, ensuring patients receive appropriate levels of care, supporting documentation, enhancing coding accuracy and compliance, and overseeing the correct utilization of diagnostic and therapeutic procedures.

• Responds promptly to requests for assistance on clinical reviews pertaining to medical necessity or other inquiries from any member of the Case Management department.

• Provides expert consultation to attending physicians, nurses, and case management associates on intricate clinical matters and advises on the necessary justification for continued patient stays, medical necessity, and utilization management.

• Develops familiarity with established criteria such as MCG/InterQual and applies professional judgment and patient-specific variables as deemed necessary or justifiable.

• Takes responsibility for achieving case management outcomes and fulfills the obligations and responsibilities associated with the role to support the medical staff in advancing patient care.

• Outlines methods to enhance health record documentation that significantly influences ICD code assignment concerning severity, acuity, mortality risk, and DRG assignment.

• Engages in ongoing training and education related to the Physician Advisor role and responsibilities, covering topics associated with Utilization Management, Care Management, and other relevant areas as requested.

• Meets productivity and quality benchmarks within designated timeframes, ensuring work product and performance align with or surpass quality standards.

• Achieves performance objectives as specified in the employment agreement.

• Maintains the confidentiality of patient care and business operations.

• Exhibits behavior that aligns with the organization’s mission and participates in mandatory orientation and training relevant to the Physician Advisor role.

• Demonstrates a commitment to meeting or surpassing the strategic initiatives of the organization.

• Upholds the organization’s values of teamwork and professionalism while applying Code of Conduct standards to all healthcare team members.

• Facilitates, mentors, and educates fellow physicians regarding payer requirements.

• Attends all meetings as requested by PAOC leadership.

• Participates in the peer review process as necessary or requested.

• Maintains valid medical licensure and board certification in good standing.

• During scheduled work hours, dedicates full attention to the Physician Advisory role and execution of assigned tasks.

• Other duties as assigned.

⛳️ Requirements

• Board Certified and licensed to practice medicine in the US or possess 3+ years of active clinical experience in the US.

• Minimum of 3 years experience as a Physician Advisor performing Level of Care reviews and Peer-to-Peer Reviews.

• Basic technical proficiency with Hospital EMRs is essential.

• Must hold and maintain an unrestricted medical license and Board Certification.

• Must possess or develop a solid foundation, knowledge, and/or experience in utilization management, quality improvement, and patient safety.

• Must have a working understanding of (Hospital) organization, case management operations, and administrative standards and policies.

• Familiarity with MCG/InterQual placement status criteria is preferred.

• Membership in the American College of Physician Advisors (ACPA) is preferred.

• Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is preferred.

• Physician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) is preferred.

• Ability to effectively present information in both formal and informal settings.

• Strong analytical skills are required.

• Proficient in Microsoft Office Suite.

• Excellent interpersonal skills with the capability to communicate effectively at all organizational levels.

• Strong problem-solving and creative skills, with the ability to exercise sound judgment and make decisions based on accurate and timely analysis.

• High integrity and dependability with a strong sense of urgency and results orientation.

• Exceptional written and verbal communication skills are required.

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off

• Flexible work arrangements

• Professional development