Physician Advisor - Fully Remote

Med-Metrix; Chicago (IL); Remote; USD 80,000 - 110,000; Full time

Job summary

An established industry player is seeking a dedicated Physician Advisor to join their team in a fully remote capacity. This role involves performing critical case reviews, collaborating with medical staff, and optimizing patient care through effective utilization management. The ideal candidate will bring a wealth of experience, including board certification and a strong understanding of hospital operations. In this position, you will play a pivotal role in ensuring compliance and enhancing documentation practices, while also mentoring fellow physicians. If you are passionate about improving healthcare outcomes and thrive in a dynamic environment, this opportunity is perfect for you.

Qualifications

• Board certified and licensed to practice medicine in the US.
• 3+ years experience as a Physician Advisor.
• Strong analytical and communication skills required.

Responsibilities

• Perform case reviews and provide consultations on clinical issues.
• Maintain accountability for achieving case management outcomes.
• Facilitate and educate other physicians regarding payer requirements.

Skills

Clinical Reviews

Utilization Management

Interpersonal Skills

Analytical Skills

Communication Skills

Education

Board Certification in Medicine

Medical License in the US

Experience as a Physician Advisor

Tools

Hospital EMRs

Microsoft Office

Microsoft Teams

Job description

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Job Purpose

The Physician Advisor performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. The Physician Advisor works closely with the Client’s medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to recommend methods to optimize use of hospital services for all patients. This includes identifying opportunities to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.

Duties And Responsibilities

1. Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management department in a timely fashion.
2. Provides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management.
3. Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable.
4. Maintains accountability for achieving case management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care.
5. Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment.
6. Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested.
7. Meets productivity and quality standards within established time requirements. Work product and performance meets or exceeds quality standards.
8. Achieve performance goals as outlined in employment agreement.
9. Maintains confidentiality of patient care and business matters.
10. Demonstrates behavior that supports the organization’s mission. Participates in required orientation and training related to the Physician Advisor role.
11. Demonstrates commitment to meeting/exceeding strategic initiatives of organization.
12. Upholds the organization’s values of teamwork and professionalism and applies Code of Conduct standards to all members of the healthcare team.
13. Facilitates, mentors, and educates other physicians regarding payer requirements.
14. Attends all meetings as requested by PAOC leadership.
15. Participates in the peer review process as may be necessary or requested.
16. Maintains medical licensure and board certification in good standing.
17. During scheduled work hours, commits full attention to Physician Advisory and execution of outlined tasks.
18. Uses, protects and discloses patients’ protected health information (PHI) only in accordance with HIPAA standards.

Qualifications

1. Board Certified and licensed to practice medicine in the US or 3+ years active clinical experience in the US.
2. 3+ years working as a Physician Advisor performing Level of care reviews as well as Peer to Peer Reviews.
3. Basic technical skills with Hospital EMRs, Microsoft Office and Teams a must.
4. Hold and maintain an unrestricted medical license and Board Certification.
5. Possess or acquire a solid foundation, knowledge, and/or experience in utilization management, quality improvement, and patient safety.
6. Possess a working knowledge of hospital organization & case management operations and policies.
7. Familiarity with MCG/InterQual placement status criteria is preferred.
8. Member of the American College of Physician Advisors (ACPA) preferred.
9. Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred.
10. Physician Advisor Sub-Specialty Certification by ABQAURP preferred.
11. Excellent customer service and interpersonal skills and utmost professionalism.
12. Able to effectively present information, both formal and informal.
13. Strong analytical skills.
14. Strong written and verbal communication skills with all levels of internal and external customers.
15. Strong organizational skills and ability to set priorities and multi-task, demonstrating flexibility and teamwork.
16. Demonstrates ability to drive results and produce outcomes.
17. Demonstrates initiative and basic independent troubleshooting skills.

Working Conditions

1. This role requires availability to provide a minimum of 16 shifts per month. Each shift is 6-8 hours and includes 4 weekend shifts per month.
2. Physical Demands: Occasionally move around, sit, perform manual tasks, operate office equipment, extend arms, kneel, talk, and hear.
3. Mental Demands: Follow directions, collaborate, and handle stress.
4. Work Environment: Usually minimal noise level.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex, parental status, national origin, age, disability, genetic information, political affiliation, military service, veteran status, or other non-merit factors.