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Physician Advisor, Utilization Management, Jackson Memorial Hospital, Full time, Days - Miami, United States - Jackson Health System
Description
Position Summary:
· The Physician Advisor (PA) serves as a clinical resource to the medical staff and Case Management/Social Work by providing identification, facilitation and resolution of utilization issues.
· The PA role reports to the CMO, CUO or his/her designee.
· The Physician Advisor addresses the following issues: level of care, Payer peer to peer correspondence, documentation, compliance, discharge planning, and hospital reimbursement and quality issues.
· Additionally, the Physician Advisor role ensures proper ensures proper status determination with support for CM/SW (case manager/social worker).
· Additionally, Physician Advisors promote understanding and cooperation between the medical staff through communication, collaboration and education.
Duties & Responsibilities:
· Acute Inpatient/Care Management Functions: Physician Advisors are expected to round on their designated units daily and be the bridge with the various medical teams and physicians to ensure appropriate utilization, and improved documentation.
· ·Participates in review of long stay patients to facilitate the use of the most appropriate level of care and to reduce readmissions. Provides feedback to attending and consulting physicians regarding level of care, length of stay, quality issues. Assists physicians with end of life care planning when appropriate.
· ·Documents response to case management referrals. Communicates with payors to justify admissions and overturn denials as appropriate, including peer to peer communication with payors.
· ·The Physician Advisor conducts clinical reviews on cases referred by care management staff and/or other health care professionals to help determine admission status, meet regulatory requirements and assure quality patient care and effective utilization of health care services.
· The PA acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, use of resources and payor requirements. The Physician Advisor works with clinical teams to resolve delays related to consultations, imaging and procedures.
· Hospital Process Improvement: Promotes coordination, communication and collaboration among all team members. Actively engage with attending physicians and residents/fellows when concurrent or retrospective review identifies a documentation issue.
· Supports the organization in quality improvement efforts requiring physician input and/or involvement.
· · Clinical Documentation Support: Acts as a liaison between the CDI professional, HIM, and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data. Educates hospital staff physicians about ICD coding guidelines and clinical Terminology.
Qualifications
Experience:
The ideal candidate has experience as a hospitalist, physician advisor, or experience with utilization review or CDI. Knowledge of, and experience with InterqQual, MCG, and major payor classes is desirable.
Education:
MD or DO degree (US or Foreign Medical Graduate) is required.
License Certification:
Active Florida medical license or house physician license (or eligibility) is required. ABQAURP certification is preferred.
