Physician Advisor 7 on 7 off

Brundage Medical Group; United States; Remote; USD 260,000 - 300,000; Full time

Job summary

Brundage Medical Group is seeking an experienced Physician Advisor to drive quality performance by coordinating with hospital physicians, utilization management, case management, CDI, the denials team, and quality staff. The PA will review cases for compliance, documentation accuracy, and appropriate utilization of health care services, and will advise on appropriate level of care.

The role includes status determinations, education of providers on documentation, and collaboration with medical

Qualifications

• MD or DO with current, unrestricted medical license in state of residence.
• Demonstrated ability to build rapport with medical staff and hospital leadership.
• Strong computer skills and EMR proficiency.
• Prior Physician Advisor experience or ≥3 years in hospital-based clinical work.

Responsibilities

• Review medical records and perform status determinations including second-level reviews.
• Review Code 44 cases and assist with length of stay management.
• Act as liaison with utilization management/case management and providers on appropriate level of care.
• Educate physicians on documentation best practices and provide feedback.
• Review denials and assist with payor communications to facilitate approvals.

Skills

Utilization Management

Interpersonal skills

Written/verbal communication

Independent work

Relationship building

Education

MD/DO

Medical license (US)

Job description

Full-time

Description

*Please note: Experienced Physician Advisor's only and no part time inquiries*

The Physician Advisor (PA) will drive quality performance across the organization by communicating with hospital physicians, utilization management, case management, CDI, the denials team, and quality staff. The PA conducts case reviews to ensure compliance, appropriate and accurate clinical documentation, and appropriate utilization of health care services. The PA acts as a consultant and resource for attending physicians regarding appropriate status, utilization of resources, need for continued hospitalization, compliance concerns and tracking and reporting of quality and complications. The PA will also interact with medical directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care.

Requirements

Duties and Responsibilities:

Utilization Management Functions

• Reviews medical records of patients identified by the UM team or as requested by the healthcare team
• Perform status determinations including 2nd level reviews and continued stay reviews for traditional Medicare patients and all other payors
• Review Code 44 cases
• Assist with length of stay management
• Work with case management and the interdisciplinary team to ensure appropriate continuity of care and reduce readmissions
• Communicate with the medical staff through secure email, secure texting applications or phone calls to relay important information and provide education
• Act as a liaison between Utilization Management/Case Management and providers to collaborate on appropriate level of care

CDI Functions

• Review documentation for clinical validity of diagnoses
• Support query response and query construction
• Educate physicians on documentation best practices
• Provide feedback to clinical providers
• Assist with pre-bill DRG

Quality Functions

• Review documentation to support quality metrics
• Educate providers on how quality is tracked and common pitfalls
• Review PSIs for appropriate assignment of complications

Denials Management Functions

• Review denials and author appeal letters as needed
• Perform peer to peers with payors
• Act as a liaison with payors to facilitate approvals and prevent denials or carved out days when appropriate

Other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES: Abilities may be accessed through written, verbal, and other evaluation methods.

• Expertise in Utilization Management preferred
• Strong interpersonal skills
• Excellent written and verbal communication skills
• Ability to work independently
• Ability to build relationships with key hospital team members

WORK EXPERIENCE, EDUCATION AND CERTIFICATIONS: List preferred/required work experience, education, and certifications.

MD or DO

Current, unrestricted medical license in state of residence

Demonstrated ability to build rapport with medical staff and hospital leadership

Strong computer skills and working knowledge of EMRs

Prior Physician Advisor experience or at least 3 years of clinical experience in a hospital-based setting

Preferred Qualifications:

• Board Certified / Eligible
• CCDS or CDIP
• CCS
• ACPA-C
• CHCQM certification (ABQAURP)

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

Conditions typically associated with an office environment. While performing the essential duties and

responsibilities, the employee is regularly required to talk or hear. May be frequently required to sit.

Moderate to prolonged reading, typing, and computer work. Ability to perform tasks involving physical

activity that may include lifting 25 pounds. Subject to exposure to all environmental hazards associated with

healthcare and office work.

Salary Description

Estimated range $260-$300k