Onsite Physician Advisor - CHRISTUS Spohn Hospital Shoreline
Company: CHRISTUS Health
Location: Corpus Christi
Posted on: June 23, 2022
The Onsite Physician Advisor is a key member of the CHRISTUS health
leadership team and is charged with meeting the organization's
goals and objectives for assuring the effective, efficient
utilization of health care services. The Physician Advisor is a---
physician serving the hospital through teaching, consulting, and
advising the care management and utilization review departments and
the hospital leadership. The Physician Advisor shall develop
expertise on matters regarding physician practice patterns, over
and under-utilization of resources, medical necessity, levels of
care, care progression, denial management, compliance with
governmental and private payer regulations, appropriate physician
coding and documentation requirements.
The Physician Advisor works closely with the 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
develop and implement methods to optimize use of hospital services
for all patients while also ensuring the quality of care provided.
This includes working with hospital leadership in developing care
management protocols with physicians and others to optimize length
of hospital stay and efficient management of resources, insuring
patients are in the appropriate level of care, supporting
documentation, coding improvements and compliance, and monitoring
the appropriate use of diagnostic and therapeutic modalities.
Reviews medical records of patients identified by care managers or
as requested by the healthcare team and in accordance with the
hospital's established Utilization Management plan in order
to:Assist with level of care and length of stay management
Assist with the denial management process
Review and make suggestions related to resource and service
Assist staff with the clinical reviews of patients
Determine if professionally recognized standards of quality are
Provides feedback to attending and consulting physicians regarding
level of care, length of stay, and quality issues.
Seeks additional clinical information from the attending and
Communicates with physicians regarding CDI query response and
clinical documentation recommendations.
Recommends next steps in coordination of care and evidence-based
Understands and applies general utilization review
guidelines/criteria while balancing this information with medical
judgement to ensure a complete review and recommendation for level
Supports care management functions in a data-driven approach.
Notifies the care manager of any conflict of interest in reviewing
a particular patient record and assists in identifying an alternate
physician to review such record.
Acts as a liaison with payers to facilitate approvals and prevent
Facilitates, mentors, and educates other physicians regarding payer
Reviews long length of stay patients in conjunction with the care
management team, and other members of the multidisciplinary team to
facilitate the most appropriate utilization of resources.
Participates in multidisciplinary rounds with the healthcare team
Identifies patients who are appropriate for an alternate level of
care and works with physicians to facilitate referrals as
Provides guidance to ED physicians and care management team
regarding status issues and alternatives to acute care when acute
care is not warranted.
Works with care management and interdisciplinary team to ensure
appropriate continuity of care and to reduce readmissions.
Provides education to physicians and other clinicians related to
regulatory requirements, appropriate utilization, alternative
levels of care, community resources, and end of life care. Works
with physicians to facilitate referrals to the continuum of
Provides education to physicians and other clinicians about proper
utilization of various acute care levels of care and assist in
creating plans to address patients who need a different level of
Supports the organization in quality improvement efforts.
Assists in the development and implementation of systems and
services that fully integrate care and reimbursement through
outcomes-based management across the continuum of care.
Facilitates collaboration of the care management infrastructure
with the medical staff to include clinical practice improvement,
approaches to reengineering care and managing practice variation,
as well as the rapid adoption of evidence-based medical guidelines
Educates individual hospital staff physicians about coding
guidelines and clinical terminology to improve their understanding
of severity, acuity, risk of mortality, and DRG assignments on
their individual patient records.
Educates specific medical staff departments regarding care
management, utilization review, and clinical documentation
Actively participates in hospital committees to support
evidence-based medicine and optimal standards of care.
Chairs or serves on the Utilization Management committee and
assists with the evaluation of the hospital utilization management
Maintains current knowledge of federal, state, and payer regulatory
and contractual requirements.
Attends continuing education sessions pertinent to case management,
utilization review, and clinical documentation integrity.
Acts as a consultant and sources to attending physicians regarding
their decisions relative to appropriateness of hospitalization,
continued stay, and appropriate use of resources.
Acts as a consultant and resource to the medical staff regarding
federal and state utilization and quality regulations.
Communicates effectively across administrative and clinical lines
to accomplish the necessary integration of hospital services in
support of medical practice within the hospital.
Reviews cases that indicate a need for issuance of a hospital
notice of non-coverage. Discusses the case with the attending
physician and if additional clinical information is not available,
discusses the process for issuance and appeal to the physician.
Participates in the facility MEC as a representative of the
Utilization Review Committee.
Participate in Revenue Integrity and Denial meetings as
Additional functions as deemed appropriate and warranted.
3 years of clinical experience required
Hold and maintain an unrestricted Texas Medical License (In process
licenses will be considered)
Meet the requirements to be a member of the medical staff and
obtain hospital privileges within 6 months of hire
Possess or acquires a solid foundation, knowledge, and experience
in the areas of utilization management, quality improvement, and
Possess a working knowledge of case management operations,
administrative standards and policies.
Strong computer skills and working knowledge of the Electronic
Familiarity with MCG/Interqual placement status criteria
Member of the American College of Physician Advisors (ACPA)
Board Certification and Physician Advisor Sub-specialty
Certification by the American Board of Quality Assurance and
Utilization Review Physicians, Inc. (ABQAURP) preferred.
Ability to build rapport with medical staff and hospital leadership
to obtain the buy-in and collaboration necessary to achieve desired
Able to serve as a resource to the Case Management staff on medical
necessity, level of care, care progression, denial management, and
resource utilization as well as liaison to the Medical Staff for
Case Management operations.
Recruiter Contact Info:
Keywords: CHRISTUS Health, Corpus Christi , Onsite Physician Advisor - CHRISTUS Spohn Hospital Shoreline, Other , Corpus Christi, Texas
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