About this opportunity
Trinity Health lists this Physician Advisor- Utilization Management & Clinical Documentation Integrity- ONSITE opportunity in athens, Georgia. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Employment Type:
nFull time
nShift:
nDescription:
nTHIS IS A 1099 POSITION
nThe Physician Advisor serves as a physician leader responsible for improving clinical documentation accuracy, case mix index (CMI), medical necessity compliance, utilization management, and hospital throughput.
nThe Physician Advisor works collaboratively with physicians, case management, clinical documentation integrity (CDI), quality, and revenue cycle teams to ensure appropriate patient status determinations, documentation accuracy, regulatory compliance, and optimal use of hospital resources.
nThis role provides in person, peer-to-peer physician engagement and education to support compliant documentation, reduce denials, decrease avoidable length of stay, and ensure appropriate utilization of hospital services.
nKey Responsibilities and Essential Functions
nClinical Documentation & Case Mix
nnnPartner with CDI specialists to improve clinical documentation accuracy and completeness
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nnProvide physician-to-physician education on documentation requirements related to:
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nnSeverity of illness
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nnRisk of mortality
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nnCC/MCC capture
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nnDRG assignment
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nnAssist with case mix index (CMI) improvement initiatives
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nnReview complex cases for documentation opportunities that accurately reflect patient acuity
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n nUtilization Management & Length of Stay Optimization
nnnProvide physician guidance for medical necessity determinations
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nnReview cases for appropriate inpatient vs observation status
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nnSupport case management staff with complex utilization reviews
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nnConduct peer-to-peer reviews with payers
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nnCollaborate with care management teams to identify and address barriers to timely discharge
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nnWork with clinical teams to reduce avoidable length of stay and excess days
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nnParticipate in daily multidisciplinary rounds and discussions to address throughput challenges and delayed discharges
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nnWork with our Internal Medicine Residents to teach them what a Physician Advisor does and how to align and balance patient care with the KPI’s the Physician Advisor works on to improve.
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n nOpportunity Days Reduction
nnnReview cases with extended length of stay to identify clinical, operational, or documentation barriers contributing to opportunity days
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nnPartner with case management, nursing leadership, and service line leaders to address drivers of avoidable hospital days
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nnProvide physician leadership in resolving delays related to:
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nnClinical decision-making
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nnDocumentation gaps
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nnDischarge readiness
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nnSpecialist consultation delays
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nnSupport hospital initiatives aimed at improving patient flow and capacity management
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n nDenials Prevention & Appeals
nnnReview payer denials related to:
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nnMedical necessity
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nnLevel of care
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nnDRG downgrades
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nnWrite and support clinical appeal letters
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nnParticipate in denials management strategy
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nnIdentify systemic issues contributing to denials and implement improvement strategies
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n nPhysician Engagement & Education
nnnProvide education to medical staff on documentation, utilization management, and efficient care delivery
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nnPresent findings at:
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nnMedical staff meetings
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nnService line meetings
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nnQuality committees
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nnServe as a physician champion for documentation improvement, medical necessity compliance, and hospital throughput
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n nQuality & Compliance
nnnEnsure hospital practices align with:
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nnCMS Conditions of Participation
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nnMedicare documentation rules
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nnTwo-midnight rule
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nnUtilization review regulations
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nnPartner with Quality and Compliance departments to ensure regulatory alignment
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n nData Review & Performance Improvement
nnnMonitor, analyze, and actively strive to improve key hospital performance metrics including, but not limited to:
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nnCase Mix Index (CMI)
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nnLength of Stay Index (Observed vs Expected LOS and %GMLOS)
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nnOpportunity Days
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nnObservation rates
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nnMedical necessity denial rates
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nnCC/MCC capture rate
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nnIdentify opportunities for clinical, operational, and documentation improvement
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n nQualifications:
nRequired
nnnMD or DO degree from an accredited institution
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nnBoard Certified in a recognized medical specialty
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nnActive unrestricted medical license to practice medicine in the state of Georgia.
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nnMinimum of 5 years clinical practice experience
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nnExperience working in hospital-based care
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nnDemonstrated leadership, people management, and team building skills
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nnMust have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
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nnAbility to develop and implement strategic clinical plans
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nnExcellent oral and written communication skills
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nnAbility to interact effectively with key internal and external constituents using collaboration and customer service skills that promote excellence in the patient experience.
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nnCustomer service orientation
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nnDemonstrated confidence, initiative, and integrity in work practices
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nnGoal-directed and well organized
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nnHigh level of dependability and accuracy
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nnAbility to work independently
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nnStrong negotiation and persuasion skills
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nnAdept at conflict management
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nnAbility to function within a stressful environment
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n nStrong computer skills and working knowledge of EMR’s
nnnA broad knowledge base of health care delivery and case management within a managed care environment
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nnComprehensive knowledge of Utilization Review, levels of care, and observation status
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n nPreferred
nnnPrior experience as a Physician Advisor, Medical Director, or Utilization Review physician
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nnExperience with:
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nnClinical Documentation Integrity (CDI)
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nnUtilization Management
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nnRevenue cycle operations
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nnDenials management
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nnLength of stay improvement initiatives
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nnKnowledge of:
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nnMS-DRG reimbursement
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nnCase Mix Index
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nnCMS inpatient admission criteria
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nnCertification such as:
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nnCHCQM-PHYADV (Certified Physician Advisor)
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nnAdditional advanced degree (MBA, MPH, MMM, etc)
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nnAwareness of healthcare reimbursement systems (HMO, PPO, PPS,CMS)
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n nOur Commitment
nRooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
nOur Commitment to Diversity and Inclusion
nTrinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
nOur dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
nEOE including disability/veteran
Worksite address
athens, GA, 30604, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.