Physician Advisor: Care Management & CDI Leadership

Health eCareers; Beaumont (TX); On-site; USD 140,000 - 200,000; Full time

Benefits offered by this job

Balanced professional and personal lifestyle

Competitive compensation and benefits

No state income tax

Relocation assistance

Job summary

A healthcare provider in Beaumont, TX, is looking for a full-time Physician Advisor to oversee Care Management and CDI initiatives. Responsibilities include leading utilization reviews, providing physician education, and ensuring compliance with regulations. Candidates should have 5 years of clinical experience and a board certification in a specialty. The position offers competitive compensation, relocation assistance, and no state income tax, encouraging a balanced lifestyle while enjoying the community's outdoor activities.

Qualifications

• 5 years of clinical experience required.
• Licensed physician must be in state of residence.
• Board certification in a clinical specialty is a must.
• Experience in utilization review preferred.
• Experience in a Utilization Management Committee is beneficial.

Responsibilities

• Lead the Utilization Review Committee.
• Conduct secondary status reviews for level of care.
• Provide education related to billing status and regulatory requirements.
• Guide Emergency Department physicians on patient intake.
• Monitor denial trends and key metrics for Utilization Management.

Skills

Clinical experience

Utilization review

Cost-efficient practice

Patient care

Mentoring

Education

Licensed physician in state of residence

Board certified in a clinical specialty

ABQUARP certification (preferred)

Job description

Description

Recruiter Contact Information:

Samantha Wallace

samantha.wallace2@

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

Roles And Responsibilities Overview

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 CDI 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!

Location: On Site - Beaumont, TX

Reporting Relationship

The PA reports directly to the Chief Medical Officer of CHRISTUS St. Elizabeth hospital.

Professional Qualifications

The Physician Advisor-Care Management and Clinical Documentation Improvement role should be staffed by a physician with the following qualifications:

• 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
  
  

Physician Advisor - Care Management & CDI Duties and Responsibilities

Utilization Management Plan: 20%

In collaboration with the Director of CM, 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 the denied cases, to resolve medical necessity issues prior to claims submission.

In Collaboration With The CMO And Director Of CM, Monitor Key Metrics For UM And Participate In Action Steps To Achieve Targets. Metrics Include (but 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 UR 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 CDI specialists

Care Management: 50%

Participate in daily IDRs takes action to expedite testing and treatment to promote efficient patient care and appropriate LOC

Provides guidance/assistance to the Emergency Department Physicians and CM staff to ensure correct LOC 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 LOC

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%

CDI query facilitation as needed

• Partner with CDI leadership to provide staff education on CDI and appropriate documentation
• Provide feedback to physicians in each service on clinical documentation using specific case examples
  
  

Highlights/ Benefits

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

Community Description

• 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
  
  

EEO is the law - click below for more information:



We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at.