MD-Physician Advisor-CDS-PRN

MD-Physician Advisor-CDS-PRN page is loaded## MD-Physician Advisor-CDS-PRNremote type:
Virtuallocations:
Presbyterian Hospital time type:
PRNposted on:
Posted 3 Days Agojob requisition :
R-369
** Location Address:
** 1100 Central Avenue SE , Albuquerque, New Mexico , United States of America
** Type of Opportunity:
** PRN
* * FTE:
** 0
*
* Summary:

** JOB PROFILE FOR PHYSICIAN ADVISOR ROLE AT PHS CDS  The Physician Advisor is a key member of the healthcare organizations leadership team and is charged with meeting the organizations 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 Medical Staff, the Utilization Review team, the Case management team and 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 progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements.
PRIMARY SCOPE OF SERVICE:
The Physician Advisor works closely with Medical Staff leadership, the entire medical staff, 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 providers, hospital leadership, case management to optimize length of hospital stay, ensuring efficient management of resources and ensuring patients are in the appropriate level of care.

This involves reviewing documentation to support current level of care, monitoring appropriate use of diagnostic and therapeutic modalities and ensuring compliance with government and payer rules for continued hospital care.
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* Job Description:

** Organization Expectations:
Participates in required orientation and training related to the Physician Advisor role Meets production standards within established time requirements. Work product and performance meet quality standards Maintains confidentiality of patient care and business matters Participates in ongoing training and education related to the Physician Advisor role, Utilization Management, Care Management and other related areas as requested Help ensure compliance with regulatory bodies such as CMS and Joint Commission Clinical Effectiveness:
Provides consultation to nurses and case management regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management. Responds to request for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management or Utilization Review department in a timely fashion. Maintains accountability for fulfilling the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care.

Works closely with Case Management on complex patient issues/discharge barriers to problem solve and expedite transfer to appropriate level of care

ESSENTIAL JOB DUTIES AND

ACCOUNTABILITIES :

Other Skills or Special Abilities Excellent customer service and interpersonal skills Strong analytical skills, written and verbal communication skills with all levels of internal and external customers Strong organizational skills and ability to set priorities and multi-task, demonstrate flexibility, teamwork and is accustomed to change in the healthcare environment Ability to effectively present information, both formal and informal

Acute Inpatient/Case Management Functions:
Assist with length of stay management and utilization of resources Review medical records of patients identified by case managers or social workers or as requested by the health care team in order to perform quality and utilization oversight Perform medical necessity reviews including initial level of care, secondary reviews and continued stay reviews and document review determinations and actions Assist with denial management process by performing…