Physician Advisor: Clinical Documentation & Utilization

St. Mary's Health Care System; Athens (GA); On-site; USD 180,000 - 260,000; Full time

Job summary

St. Mary’s Health Care System in Georgia seeks a Physician Advisor to lead clinical documentation improvement, utilization management, and hospital throughput.

The role collaborates with CDI, quality, and revenue cycle teams to ensure compliant status determinations and optimal resource use. You will engage physicians in education on documentation requirements, DRG capture, and medical necessity, supporting timely discharges while reducing denials and LOS.

Qualifications

• MD or DO degree from an accredited institution.
• Board Certified in a recognized medical specialty.
• Active unrestricted medical license to practice medicine in the state of Georgia.
• Minimum of 5 years clinical practice experience.
• Experience working in hospital-based care.
• Demonstrated leadership, people management, and team building skills.
• Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
• Ability to develop and implement strategic clinical plans.
• Excellent oral and written communication skills.
• Ability to interact effectively with key internal and external constituents using collaboration and customer service skills that promote excellence in the patient experience.

Responsibilities

• Improve clinical documentation accuracy and completeness.
• Assist with case mix index (CMI) improvement initiatives.
• Provide physician-to-physician education on documentation requirements.
• Review complex cases for documentation opportunities reflecting patient acuity.
• Provide physician guidance for medical necessity determinations.
• Review cases for inpatient vs observation status.
• Support case management with complex utilization reviews.
• Conduct peer-to-peer reviews with payers.
• Collaborate with care management to address discharge barriers.
• Teach Internal Medicine Residents about Physician Advisor roles and KPI alignment.
• Ensure compliance with CMS and Medicare documentation rules.
• Monitor performance metrics like CMI, LOS, opportunity days, and denial rates.

Skills

MD/DO degree

Board Certified

GA license

5+ years clinical practice

Hospital-based care

Leadership

Time management

Strategic clinical planning

Communication skills

Collaboration

Education

MD/DO degree

CHCQM-PHYADV

Tools

EMR proficiency

Job description

St. Mary’s Health Care System in Georgia seeks a Physician Advisor to lead clinical documentation improvement, utilization management, and hospital throughput.

The role collaborates with CDI, quality, and revenue cycle teams to ensure compliant status determinations and optimal resource use. You will engage physicians in education on documentation requirements, DRG capture, and medical necessity, supporting timely discharges while reducing denials and LOS.