Days 4/ 10 hr days or MOn- Fri
CHRISTUS Central Louisiana/St. Frances Cabrini
CHRISTUS St Frances Cabrini-40100
3330 Masonic Dr
Alexandria, LA 71301
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The Physician Advisor reviews clinical cases referred by case management staff or other health care professionals to meet regulatory requirements and in accordance with the hospitals objectives for assuring quality patient care and efficient utilization of health care services. The Physician Advisor meets with case management and health care team members, including attending physicians and specialist, to discuss selected cases and make recommendations for care. The Physician Advisor also interacts with medical directors of third party payers to discuss the needs of the patients and alternative levels of care. The Physician Advisor acts as a consultant to and resource for attending physicians relative to the appropriateness of hospitalization, continued stay, and use of resources, as well as federal and state utilization and quality regulations. The Physician Advisor needs to have strong computer skills and working knowledge of electronic medical records, and ability to work as a part of a team.CHRISTUS COMPETENCIES FOR ASSOCIATES Action oriented - Taking on new opportunities and tough challenges with a sense of urgency, high energy, and enthusiasm. Customer focus- Building strong customer relationships and delivering customer-centric solutions. Communicates effectively- Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences. Decision quality- Making good and timely decisions that keep the organization moving forward. Collaborates- Building partnerships and working collaboratively with others to meet shared objectives. Nimble learning- Actively learning through experimentation when tackling new problems, using both successes and failures as learning fodder. Demonstrates self-awareness- Using a combination of feedback and reflection to gain productive insight into personal strengths and weaknesses. MAJOR RESPONSIBILITIES
Acute Inpatient Case Management Functions:
Reviews medical records of patients identified by case managers or other health care team members to assist with level of care and length of stay management. Assist with the denials management process, review and make suggestions related to resource and service management, assist staff with clinical review of patients, determine if professional standards of quality are met. The Physician Advisor will also provide feedback to attendings and consulting physicians regarding level of care, length of stay, and quality issues. Obtain additional clinical information from the attending or specialists and request more complete documentation in the medical record. Recommend steps in coordination of care. The Physician Advisor will review cases that indicate a need for issuance of a hospital notice of non-coverage, and discuss the process for issuance and appeal to the physicians.
Document patient care reviews in response to case management referrals. Understand and use InterQual, Milliman, and other appropriate criteria. Support case management in data-driven approach to improve efficient use of services. The Physician Advisor will notify case management of any conflict of interest in reviewing a particular case. Act as a liaison with payers to facilitate approvals and prevent denials. Participate in the review of long stay patient, or high cost outliers, in conjunction with case management leadership. The Physician Advisor will participate in patient rounds when indicated. Assist with the identification of patients who are appropriate for LTACH facilities or swing bed. Assist ED physicians with status issues and alternatives to acute care when acute care is not warranted. The Physician Advisor works with the physicians, case management, and other hospital staff to reduce readmissions. The Physician Advisor will provide education to the physicians on regulatory requirements, appropriate utilization, alternate level of care, and end of life care. Promotes coordination, communication, and collaboration among all team members.
The Physician Advisor will identify quality, safety, patient satisfaction, and efficiency issues that lead to suboptimal care, and takes actions to resolve them. The Physician Advisor may be asked to physician quality issues and respond to patient concerns on care provided. The Physician Advisor will support quality improvement efforts that require physician involvement. The Physician Advisor will work with physicians, case management department, and finance in identifying concerns in efficient utilization of services, include appropriate length of stay. The Physician Advisor will participate in hospital committees to support optimal level of care. Chairs or serves on the Utilization Management Committee. Make presentations to the Medical Staff, Board, and Administration when warranted. Assist in the evaluation of the utilization management program. Maintains current knowledge of the federal, state, and payer regulatory and contract requirements. Additional functions as deemed appropriate and warranted.POSITION SPECIFIC COMPETENCIES
Clinical Documentation and Utilization Management are closely associated. Currently, the expected focus of the Physician Advisor will be on utilization management. However, the Physician Advisor is expected develop expertise clinical documentation improvement.
- Graduate of an accredited medical school. Education in Quality and Utilization Management through CME or self-study.
- Minimum of 5 years recent experience in clinical practice. Utilization management experience as member of a utilization management committee or prior experience as a physician advisor is preferred.
- Medical License in the state of Louisiana is preferred. Board certified or Board eligible in their specialty.