Physician Advisor Job Description
Physician advisor
provides education to physicians and case managers on denial and payor trends, Interqual and admission criteria, documentation, and CMS/other regulatory requirements and updates.
Physician Advisor Duties & Responsibilities
To write an effective physician advisor job description, begin by listing detailed duties, responsibilities and expectations. We have included physician advisor job description templates that you can modify and use.
Sample responsibilities for this position include:
Acts as consultant and resource to the medical staff regarding federal and state utilization and quality regulations
Work directly with C-Suite members, physicians, clinicians and other senior leaders within the healthcare organization and the company to ensure goals are met
Provide input and medical expertise to the internal team when assessing and researching hospital clinical initiatives
Recommend new or alternative approaches
Evaluate, interpret, recommend and implement decisions arrived at by the Value Analysis teams
Ensure Value Analysis Committees adhere to established medical standards and guidelines
Communicate with senior management to ensure effectiveness of the overall team
Assemble and manage physician team leaders and ad hoc subject matter experts in the course of completing clinical initiatives
Review products and suggest benefits, efficacy and relevancy to teams
Attend committee and steering meetings
Physician Advisor Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Physician Advisor
List any licenses or certifications required by the position: GOLD, D.O, M.D, ABMS, ABQAURP, IRS, CME
Education for Physician Advisor
Typically a job would require a certain level of education.
Employers hiring for the physician advisor job most commonly would prefer for their future employee to have a relevant degree such as Master's and Bachelor's Degree in Business, Osteopathic Medicine, Medicine, Health Care Administration, Education, Medical, Healthcare Administration, Technical, Leadership, Health Care
Skills for Physician Advisor
Desired skills for physician advisor include:
EMRs
Millman criteria
With Interqual
Applicable ICD-10
Applicable clinical criteria and relevant AIM policies pertaining to utilization review
Federal
Basic principles of utilization management and quality assessment
Payer regulatory and contract requirements
State
Cardiac services
Desired experience for physician advisor includes:
Represent the company at the hospital, new client engagements, on site office and national meetings
Communicate value analysis activities, results and decisions throughout the organization
Work directly with C-Suite members, physicians, clinicians and other senior leaders within the healthcare organization
Attend CDI meetings
Attend Utilization Management meetings
Attend Medical Staff meetings as necessary and appropriate
Physician Advisor Examples
1
Physician Advisor Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of physician advisor. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for physician advisor
- Discuss determination with requesting physicians or ordering providers, when available within the regulatory timeframe of the request by phone or fax
- Provide clinical rational for standard and expedited appeals
- Provide assistance to initial clinical reviewers as needed to discuss cases and problems
- Participate in daily review of aggregate denials/appeals with the Medical Director, peer, and or the Clinical Review Supervisor
- Utilize medical review guidelines and parameters to assure consistency in the MD review process so as to reflect appropriate utilization and compliance with NIA’s polices/ procedures, URAC and NCQA guidelines
- Document all communication with medical office staff and/or MD provider is recorded in a timely and accurate manner
- Participate in any type of peer review
- Responsible for reviewing and authorizing inpatient days and the evaluation of inpatient utilization patterns within service areas to identify areas of improvement, developing specific strategies and criteria addressing areas of need
- Participates with the Medical Directorate to review and develop medical guidelines and policies
- Reviews data and trends to identify opportunities for utilization improvement to positively influence practice patterns
Qualifications for physician advisor
- Collaborates and develops relationships with payers and the community health resources
- Acts as a liaison between contracted Managed Care/Commercial payers related to managed care denials, Care Management and the Hospital’s Medical Staff to facilitate the accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, in addition to DRG assignment
- Strives to improve the quality of care through the adherence of evidence based guidelines/protocols, reduction of medication adverse drug events, and minimizing cost
- Use a clinical authoring tool and additional technologies to collaboratively codify clinical rules and implement evidence-based workflows
- Create messaging with collaboration from legal and compliance stakeholders
- Apply clinical information technology and clinical process improvement to support best clinical practices and standardization of care
2
Physician Advisor Job Description
Job Description Example
Our company is looking to fill the role of physician advisor. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for physician advisor
- Using software development life cycle methodology, adhere to best practices in clinical authoring and IT
- Request and analyze reports to monitor performance of algorithms and identify opportunities for enhancements
- Create reports and presentations for key stakeholders
- Engage in mapping of ICD-10 and CPT codes
- In partnership with Reporting and Analytics, use data for predictive analysis and help guide business decisions
- Work with advanced graphic tools, including dashboards and other visual displays, to
- Provide reports that highlight variations in utilization, clinical practice, and clinical outcomes
- Support research activities through basic reporting functions and analysis
- The Case Management Medical Advisor serves as a resource to the Case Management staff on medical necessity, level of care, care progression, denial management, and resource utilization liaison to the Medical Staff for Case Management operations
- Conducts clinical review on cases referred by Case Management staff and/or other health care professionals in accordance with the hospital's established Utilization Management Plan
Qualifications for physician advisor
- Minimum 3 years of physician case reviewer experience preferred
- Familiarity with Specialty Pharmacy drugs preferred
- Familiarity with clinical decision support desirable
- Meets the hospital's objectives for assuring quality patient care and effective, efficient utilization of health care services while also meeting regulatory requirements
- Meets with Case Management and health care team members to discuss selected cases and make recommendations related to care progression
- Interacts with medical staff members and medical directors of third party payers to discuss the needs of patients, access to care and alternative levels of care
3
Physician Advisor Job Description
Job Description Example
Our growing company is hiring for a physician advisor. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for physician advisor
- Provides education and feedback on the impact of improved documentation to medical staff (medical staff meetings, newsletters, memos)
- Working with in-patient staff and physicians other Hospital departments (Quality, Risk, Case Management, Coding, Finance, Denials Management, ), interprets and abstracts data from medical records and organizes data in format for appeal submission
- Develops and maintains log on appeal dates, decisions and follow up dates
- Actively participate as UM subject matter expert on inter and intra departmental meetings
- Maintain and develop up to date clinical knowledge and trends
- Engage in mapping of ICD-10, CPT codes
- Determines the medical necessity of requests using clinical criteria
- Performs physician-level case review of musculoskeletal utilization requests
- Conducts peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging and appropriate sites of service
- Provides education regarding applicable clinical criteria and discusses clinically appropriate alternative surgical and non-surgical treatments
Qualifications for physician advisor
- Knowledge of, and comfort using Microsoft Word, Excel, and Visio
- Minimum of five years of experience in hospital acute care
- Experience in Utilization management and familiarity with its principles is preferred
- Proven capability to communicate and to develop positive relationships with physician colleagues
- Demonstrates objectivity, flexibility, and tact in dealing with potentially sensitive medical staff issues, practice patterns, and clinical resource utilization
- Demonstrates knowledge, use, and support of protocols, practice guidelines
4
Physician Advisor Job Description
Job Description Example
Our innovative and growing company is looking to fill the role of physician advisor. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for physician advisor
- Provides support and education to internal clinical and non-clinical staff regarding the principles associated with appropriate musculoskeletal diagnoses, treatments, and management
- Participates in physician team meetings
- Participates in groups that develop, revise and enhance clinical appropriateness guidelines
- Assists and manages the denial management process
- Provide feedback and education to the Care Management and Clinical Documentation Departments through written and verbal communication appropriate tracking and trending for process improvement efforts
- Proactively interacts with facility PA’s and medical staff by seeking additional clinical information and documentation from physicians, discussing the patient’s medically appropriate needs, suggesting alternative treatment plans and options and recommending appropriate next steps
- Reviews and analyzes outcomes and participates in the development of action plans related to utilization and other Case Management activities
- Reinforces evidenced-based medicine best practices and adherence to reduction in clinical variation
- Performs and educates/supports facilities in medical record audits and governmental reviews
- Participates in interdisciplinary rounds and supports care team communication and coordination activities within WFD
Qualifications for physician advisor
- Understanding of databases and basic querying
- Perform physician-level case review, following initial nurse review, of high-tech diagnostic imaging, modalities
- Demonstrated knowledge of current practice standards in interventional pain management
- Managed care/administrative experience in a network environment
- Proficiency in Microsoft Office applications, email, Internet, electronic documentation skills
- Licensed physician with minimum of 5 years clinical practice experience
5
Physician Advisor Job Description
Job Description Example
Our company is looking for a physician advisor. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for physician advisor
- Performs review of individual cases, upon referral, identified in interdisciplinary rounds, and as identified in the in the facility CMS’ Utilization Management Plan requirements
- Communicates activities and outcomes in a timely manner to involved members of the health care team
- Documents UR and care coordination interventions and outcomes appropriately in the Case Management software tool
- Acts as a liaison between facility PA’s, Case Management staff, and Medical Staff for cases which cannot be resolved at the Case Management and/or facility PA level
- Serves as a liaison with third party payers’ Medical Management teams
- Performance will be benchmarked against case management, utilization, denial management goals of facilityWFD
- Maintains a record of Physician Advisor activity per facility WFD policy
- Upon request, participates in, and chairs if requested, the facility UR Committees
- Educates, supports, and mentors facility PA’s as needed to achieve competency and goal satisfaction
- Ensure WFD PA’s complete assigned education/training within required timeframe
Qualifications for physician advisor
- Familiarity with standard medical coding schemes (ICD-10, HCPCS, CPT-4)
- Training/certification in informatics a plus
- Utilization Management and hospital committee chair experience preferred
- Minimum of five years clinical practice experience
- MD/DO and is currently licensed and board certified
- An advanced business degree is preferred