Job Purpose
The Physician Advisor II serves as a leader on the Physician Advisor team, mentoring, teaching internally and externally, maintaining quality across the spectrum of Physician Advisors, and manages PAOC relationships with clients. Additionally, the Physician Advisor II performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. The Physician Advisor II 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 while also ensuring the quality of care. 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
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
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
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
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
Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment
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
Meets production standards within established time requirements. Work product and performance meets quality standards
Achieve performance goals as outlined in employment agreement
Maintains confidentiality of patient care and business matters
Demonstrates behavior that supports the organization’s mission. Participates in required orientation and training related to the Physician Advisor role
Demonstrates commitment to meeting/exceeding strategic initiatives of organization
Upholds the organization’s values of team work and professionalism and applies Code of Conduct standards to all members of the healthcare team
Facilitate, mentor, and educate other physicians regarding payer requirements
Attends all meetings as requested by PAOC leadership
Participate in the peer review process as may be necessary or requested
Maintain medical licensure and board certification in good standing
Manages client relationships for PAOC, directing quarterly report creation and JOCs (in concert with the Director of Operations), achieving customer satisfaction and retention
Contributes to execution of PAOC’s Quality program and continuous PA development
Provides education to client facilities’ staff on a variety of relevant topics
Mentors and trains new Physician Advisors as well as existing Physician Advisors to ensure the highest possible consistency and quality for PAOC determinations
Serves as Team Lead for Physician Advisors for Dashboard management as scheduled
Fulfills additional duties as needed within the Physician Advisor II role
Other duties as assigned
Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act…