Physician Advisor - Remote
RemoteUnited States
Job Summary
Conduct case reviews of all case types to optimize hospital service use, ensuring appropriate patient care levels and efficient resource management. Provide consultations to attendings, nurses, and case management staff regarding complex clinical issues, medical necessity, and utilization management. Apply professional judgment to support documentation, coding improvements, and diagnostic/therapeutic modality monitoring while describing methods to improve health record documentation for accurate ICD code assignment and DRG capture. Respond to clinical review requests from the Case Management department and participate in peer review processes as requested. Maintain confidentiality of protected health information in accordance with HIPAA standards and commit to productivity and quality standards within established time requirements.
Required Qualifications
- Board Certified and licensed to practice medicine in the US
- 3+ years active clinical experience in the US
- 3+ years working as a Physician Advisor performing Level of care reviews as well as Peer to Peer Reviews
- Basic technical skills with Hospital EMRs
- Hold and maintain an unrestricted medical license
- Board Certification
- Possess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety
- Possess a working knowledge of (Hospital) organization & case management operations and administrative standards and policies
- Able to effectively present information, both formal and informal
- Strong analytical skills
- Proficiency in Microsoft Office Suite
- Strong interpersonal skills, ability to communicate well at all levels of the organization
- Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results oriented
- Excellent written and verbal communication skills
- Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes
Desired Qualifications
- Familiarity with MCG/InterQual placement status criteria
- Member of the American College of Physician Advisors (ACPA)
- Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP)
- Physician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP)
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