Physician Advisor

Physician Advisor

CHRISTUS Health St. Elizabeth is seeking a full-time, in-person Physician Advisor to join the team in Beaumont, TX!

Job Description

• The Physician Advisor is an administrative physician role serving CHRISTUS St. Elizabeth hospital 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 PA also ensures physician support and execution for the Care Management and Clinical Documentation Improvement 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 PA will submit monthly time records documenting time actually spent in the provision of the responsibilities outlined below. M-F, no call responsibilities!

Requirements

• 5 years of clinical experience
• Licensed physician in state of residence
• Board certified in a clinical specialty
• Certified by the American Board of Quality Assurance and Utilization Review Physicians, Inc (ABQUARP) - preferred
• Experienced in clinical practice with an understanding of utilization review
• Served on or chaired a Utilization Management Committee
• Demonstrated cost-efficient practice

Duties and Responsibilities

Utilization Management Plan: 20%

• In collaboration with the Director of Care Management, lead the Utilization Review Committee.
• Conduct secondary status reviews for appropriate level of care determination.
• Conduct peer-to-peer consults with the payor medical directors for denied cases to resolve medical necessity issues prior to claims submission.
• In collaboration with the Chief Medical Officer and Director of Care Management, monitor key metrics for Utilization Management and participate in action steps to achieve targets. Metrics include (but are 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 Utilization Review 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 Clinical Documentation Improvement specialists.

Care Management: 50%

• Participate in daily Interdisciplinary Rounds (IDRs) taking action to expedite testing and treatment to promote efficient patient care and appropriate Level of Care.
• Provide guidance/assistance to the Emergency Department Physicians and Care Management staff to ensure correct Level of Care 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 Level of Care.
• 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 InterQual and MCG 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%

• Clinical Documentation Improvement query facilitation as needed.
• Partner with Clinical Documentation Improvement leadership to provide staff education on Clinical Documentation Improvement and appropriate documentation.
• Provide feedback to physicians in each service on clinical documentation using specific case examples.

Benefits

• Balanced professional and personal lifestyle
• Competitive compensation and benefits
• No state income tax
• Relocation assistance

Community Overview

• Easy drive to Houston
• Enjoy the lush green countryside, pine tree-covered hills, and lakes.
• Year-round outdoor activities include golfing, hunting, fishing, camping, hiking, and boating.
• Excellent public and private schools.