Physician - Advisor (Care Management & CDI) - Tyler, United States - Christus Health

Description

Physician-Advisor(Care Management and CDI)

Physician Advisor - Care Management &CDI

Roles andResponsibilities Overview
The PhysicianAdvisor-Care Management and Clinical Documentation Improvement(PACM) is a full-time administrative physician role serving MotherFrances Hospital -Tyler (MFH-T) and its affiliates throughteaching, consulting, and advising both the Care ManagementDepartment and the medical staff on matters regarding physicianpractice patterns, documentation, over- and under-utilization ofresources, medical necessity, compliance rules and regulations,collaboration and relationships with payers, and the community. ThePACM also ensures physician support and execution for the CareManagement and CDI Departments' initiatives by promoting effectiveand efficient physician documentation to support the patient'sLevel of Care (LOC), billing status, and appropriateness ofMedicare Severity-Diagnosis Related Group (MS-DRG)/DRG assignment.The PACM will submit monthly time records documenting time actuallyspent in the provision of the responsibilities outlined below. M-F,no call responsibilities

ReportingRelationship
The PACM reports directly to theChief Medical Officer of Mother Frances Hospital -Tyler with adotted line to the Chief Financial Officer - Tyler

Professional Qualifications
The Physician Advisor-Care Management and Clinical DocumentationImprovement role should be staffed by a physician with thefollowing qualifications:

• ·Licensedphysician in state of residence
• Board certifiedin a clinical specialty
• ·Certified by theAmerican Board of Quality Assurance and Utilization ReviewPhysicians, Inc (ABQUARP) -preferred
• ·Experienced in clinical practicewith an understanding of utilizationreview
• ·Served on or chaired an UtilizationManagement Committee
• ·Demonstratedcost-efficient practice

Physician Advisor - Care Management & CDIDuties and Responsibilities

Utilization Management Plan: 20%

•In collaboration with the Director of CM, leadthe Utilization Review Committee

•Incollaboration with the Director of CM, monitor key metrics for UMand participate in action steps to achieve targets. Metrics include(but not limited to):

•Denial trends, appeals& recoveries

•Length of stay- inpatient andobservation

•Condition Code 44

Physician & Staff Education: 15%

•Provide education to physicians and otherclinicians related to regulatory requirements, appropriate billingstatus and utilization of alternate levels of care, communityresources, and end of life care.

•Work withphysicians to facilitate referrals to the continuum of care

•Facilitate, mentor, and educate otherphysicians regarding payer requirements

•Provide mentoring/coaching to UR Case Managers toincrease knowledge in care progression

•Educatephysicians on the benefits and importance of a clinicaldocumentation program and how to work with CDI specialists

Care Management:50%

•Participate in daily IDRs takesaction to expedite testing and treatment to promote efficientpatient care and appropriate LOC

•Providesguidance/assistance to the Emergency Department Physicians and CMstaff to ensure correct LOC designation at intake

•Act as a liaison with payers to facilitate approvals andprevent denials or carved-out days when appropriate

•Participate in review of long-stay patients escalatedfrom Care Management to facilitate the use of the most appropriateLOC

•Review cases that indicate a need forissuance of a hospital notice of non-coverage determination.Discuss the case with the attending physician and if additionalclinical information is not available, discuss the process forissuance and appeal with the physician.

•Document patient care reviews, decisions, and otherpertinent information per hospital policy

•Possess foundational knowledge of InterQuale criteria

•Participate in Care Management Leadership& staff meetings to help identify and progress towarddepartmental goals

•Notify the Care Manager ofany conflict of interest in reviewing a particular patient record.Assist with identifying a physician to review such record.

Clinical Documentation Integrity15%

•Provide feedback to physiciansin each service on clinical documentation using specific caseexamples/3M

Highlights/Benefits:

• Balancedprofessional and personal lifestyle
• Competitivecompensation and benefits
• No state incometax
  
• Relocationassistance

CommunityDescription:

• Easy drive toDallas
• Enjoy the lush green countryside, pinetree-covered hills and lakes.
• Year-roundoutdoor activities include golfing, hunting, fishing, camping,hiking, and boating.
• Excellent public andprivate schools

RecruiterContact Information:

Recruiter ContactInformation:

Britni Long

Email:

britni. . org

Work Type:

Full Time

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