CDI Physician Advisor

01 Kaweah Delta Health Care District; Visalia (CA); On-site; USD 193,000 - 289,000; Full time

Benefits offered by this job

Benefits Eligible

Job summary

Kaweah Health in Visalia, CA, seeks a Physician Advisor to serve as a clinical liaison among medical staff, case management, and hospital administration. The role ensures appropriate resource utilization, supports accurate documentation, and promotes regulatory compliance while guiding medical necessity decisions.

The position emphasizes leadership, collaboration with utilization review teams, and continuous improvement in inpatient documentation and case management processes.

Qualifications

• Current MD/DO license in good standing.
• Experience in utilization review, case management, or physician advisory services.
• Strong knowledge of CMS regulations, payer guidelines, and clinical documentation standards.

Responsibilities

• Serve as the physician champion for UM and CDI, driving provider alignment and accountability.
• Influence practices through peer-to-peer leadership and clinical credibility.
• Provide real-time physician-to-physician consultation regarding admissions, utilization management, and documentation.
• Collaborate with case management and utilization review teams to optimize patient flow and resource use.
• Review patient cases for medical necessity, appropriate level of care, and length of stay.
• Monitor LOS outliers; work with care teams to improve throughput and avoid delays.
• Ensure inpatient documentation reflects severity, mortality risk, and medical decision-making.
• Improve capture of diagnoses and comorbidities for DRGs and outcomes.

Skills

Communication

Analytical skills

Leadership

Education

MD/DO license

ABQAURP CPA

Job description

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care. It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do — in the health of our patients, our loved ones, and our community.

• Benefits Eligible Not Benefits Eligible Work Shift Variable - 10 Hour Shift (United States of America) Department 8792 Documentation

The Physician Advisor serves as a clinical liaison between medical staff, case management, and hospital administration. This role focuses on ensuring appropriate utilization of hospital resources, supporting accurate clinical documentation, and promoting compliance with regulatory and payer requirements. The Physician Advisor also provides guidance on medical necessity, level of care determinations, and denial prevention.

Pay Range $139.76 -$209.64

Qualifications

• License /Certification Required:Current MD/DO
• Preferred: Certification from the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP), including Certified Physician Advisor (CPA)
• Experience Required: Minimum of three years of clinical practice experience.
• Preferred: Minimum of three years of clinical practice experience in a hospital setting
• Experience with utilization review, case management, or physician advisory services
• Knowledge/Skills/Abilities Strong knowledge of CMS regulations, payer guidelines, and clinical documentation standards
• Excellent communication, analytical, and leadership skills

Job Responsibilities

• Essential Serves as the physician champion for UM and CDI, driving provider alignment and accountability
• Influences practices through peer-to-peer leadership and clinical credibility.
• Provides real-time physician-to-physician consultation regarding admissions, utilization management, and documentation.
• Collaborates with case management and utilization review teams to optimize patient flow and resource use.
• Reviews patient cases for medical necessity, appropriate level of care, and length of stay.
• Monitors and addresses length of stay (LOS) outliers; collaborates with care teams to promote efficient, high-quality patient throughput.
• Ensures inpatient documentation accurately reflects severity of illness, risk of mortality, and medical decision-making.
• Improves capture of principal diagnoses, comorbidities, and complications impacting DRGs and quality outcomes.
• Reduces denials, audits, and compliance risk through defensible, clinically sound documentation.
• Supports accurate reporting of inpatient quality measures and public-facing metrics.
• Optimizes case mix index (CMI) and reimbursement through improved inpatient documentation integrity.
• Decreases length-of-stay variance and documentation-related delays impacting throughput.
• Leverages inpatient CDI analytics to identify high-impact opportunities and drives continuous improvement.
• Monitors physician response rates, query effectiveness, and documentation trends.
• Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.
• Performs other duties as assigned.