Onsite Physician Advisor: Utilization & Care Leader

CHRISTUS Health; San Antonio (TX); On-site; USD 180,000 - 240,000; Full time

Job summary

CHRISTUS Health is seeking a Physician Advisor who will report to the System Medical Director for Physician Advisory services and serve as a resource to utilization review, care management, and medical staff on medical necessity, level of care, patient progression, and denial management.

The leader will provide consultation on hospitalization appropriateness, continued stay, and resource utilization, while supporting regulatory compliance and CHRISTUS Health strategic priorities.

Qualifications

• MD or DO degree from an accredited medical school.
• 5 years of experience in the clinical setting.
• 2 years of experience in a physician advisor role or equivalent.
• 2 years of leadership and/or management experience.
• Board-certified in a clinical specialty.
• Board certification in HCQM (ABQMURP) preferred.

Responsibilities

• Conduct status reviews to assess medical necessity of hospitalizations and level of care.
• Perform peer-to-peer consults with payer medical directors to resolve denials.
• Support compliance with state and federal regulations and CHRISTUS Health priorities.
• Collaborate with care management and healthcare teams on appropriate care progression.
• Participate in denial meetings to identify opportunities and reduce denials.
• Consult CDI team for query facilitation and transfer center for challenging reviews.
• Develop and present analysis of short-term projects to leadership.

Skills

CMS/insurance knowledge

Analytical skills

Organizational skills

Communication skills

Stakeholder relationship building

EMR/computer skills

Strategic alignment with CHRISTUS

Education

MD or DO

Board-certified in clinical specialty

Tools

EMR systems

Job description

CHRISTUS Health is seeking a Physician Advisor who will report to the System Medical Director for Physician Advisory services and serve as a resource to utilization review, care management, and medical staff on medical necessity, level of care, patient progression, and denial management.

The leader will provide consultation on hospitalization appropriateness, continued stay, and resource utilization, while supporting regulatory compliance and CHRISTUS Health strategic priorities.