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Physician Advisor - Fully Remote

Med-Metrix

Chicago, IL(remote)

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JOB DETAILS
JOB TYPE
Full-time
SKILLS
Analysis Skills, Authentication, Business Strategy, Case Management, Certified Case Manager (CCM), Clinical Advice, Clinical Medicine, Clinical Validation, Communication Skills, Community and Social Services, Diagnosis-Related Group (DRG), Discharge Plans, Documentation, Electronic Medical Records, Genetics, HIPAA (Health Insurance Portability and Accountability Act), Healthcare, Hospital, Information/Data Security (InfoSec), International Classification of Diseases (ICD), Interpersonal Skills, Leadership, Maintain Compliance, Medical Office Administration, Medical Records, Medicine, Mentoring, Microsoft Office, Military, Office Equipment, Patient Care, Patient Confidentiality, Peripheral Hardware, Presentation/Verbal Skills, Problem Solving Skills, Quality Assurance, Quality Management, Quality Metrics, Quality of Care, Resource Management, Risk, Security Compliance, Smartphones, Social Work, State Laws and Regulations, Strategic Planning, Team Player, Time Management, Utilization Management, Writing Skills
LOCATION
Chicago, IL
POSTED
24 days ago
Job PurposeThe Physician Advisor performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. The Physician Advisor 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. 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 ResponsibilitiesResponds 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 fashionProvides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization managementObtains 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 justifiableMaintains 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 careDescribes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignmentParticipates 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 requestedMeets productivity and quality standards within established time requirements. Work product and performance meets or exceeds quality standards.Achieve performance goals as outlined in employment agreementMaintains confidentiality of patient care and business mattersDemonstrates behavior that supports the organization’s mission. Participates in required orientation and training related to the Physician Advisor roleDemonstrates commitment to meeting/exceeding strategic initiatives of organizationUpholds the organization’s values of teamwork and professionalism and applies Code of Conduct standards to all members of the healthcare teamFacilitate, mentor, and educate other physicians regarding payer requirementsAttends all meetings as requested by PAOC leadershipParticipate in the peer review process as may be necessary or requestedMaintain medical licensure and board certification in good standingDuring scheduled work hours, commits full attention to Physician Advisory and execution of outlined tasksOther duties as assigned Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standardsUnderstand and comply with Information Security and HIPAA policies and procedures at all times Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties QualificationsBoard Certified and licensed to practice medicine in the US or 3+ years active clinical experience in the US3+ years working as a Physician Advisor performing Level of care reviews as well as Peer to Peer ReviewsBasic technical skills with Hospital EMRs a mustHold and maintain an unrestricted medical license and Board CertificationPossess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safetyPossess a working knowledge of (Hospital) organization & case management operations and administrative standards and policiesFamiliarity with MCG/InterQual placement status criteria is preferredMember of the American College of Physician Advisors (ACPA) preferredBoard Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferredPhysician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferredAble to effectively present information, both formal and informalStrong analytical skillsProficiency 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 required Working ConditionsThis role requires availability to provide a minimum of 16 shifts per month. Each shift is 6-8 hours in duration and includes 2 weekend shifts per month.Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.Work Environment: The noise level in the work environment is usually minimal.Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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Med-Metrix

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