Physician Advisor
- Req ID: req5121
- City, State: New Brunswick, NJ
- Job Type: On-Site
- Job Schedule: Part-Time
Physician Advisor
Physician Advisors Department
The Physician Advisor is a physician who works closely with the Clinical Documentation & Care Coordination Departments to provide medical direction for many diverse functions, which includes: facilitating resolution of utilization issues related to establishing medical necessity for an inpatient admission or observation/outpatient encounter; addresses matters related to progression of care, which is accomplished through advising and consulting with the medical staff and all clinical groups involved; appeals admission denials with insurance payers; and provides clinical support to Clinical Documentation Integrity (CDI) staff.
The Physician Advisor will:
• Provide timely reviews and medical decision-making ensuring patients are in the appropriate level of care in compliance with governmental regulations, conditions of participation and commercial insurance contracts.
• Assist with the denial management/appeal process by engaging in insurance payer Peer-to-Peer discussions, and retrospective payer admission/DRG denials.
• Provide advice regarding resource management, including whether certain tests, procedures, or consultations could be safely and appropriately deferred to the outpatient setting.
• Provide feedback to attending and consulting physicians regarding level of care, length of stay, and throughput issues. Seeks additional clinical information from the attending and consulting physicians. Recommend and requests additional, more complete, medical record documentation.
• As needed, participates in the Utilization Review Committee.
• Provide clinical advice relative to coding inquiries for Clinical Documentation Integrity (CDI) staff. Assists in clarifying documentation in the medical record. Provides physician-to-physician contact for coding or clinical documentation issues.
• Provide guidance and expertise, when requested, in the evaluation of payer contracts.
Requirements:
• Licensed physician in the State of New Jersey; Board Certification desired.
• Minimum of five or more years of clinical practice in an acute care hospital setting.
• Excellent verbal, written and interpersonal communication skills.
• Ability to interact with the medical staff to obtain the buy-in and collaboration necessary to achieve desired outcomes.
Grade 138
Physician Advisors Department
The Physician Advisor is a physician who works closely with the Clinical Documentation & Care Coordination Departments to provide medical direction for many diverse functions, which includes: facilitating resolution of utilization issues related to establishing medical necessity for an inpatient admission or observation/outpatient encounter; addresses matters related to progression of care, which is accomplished through advising and consulting with the medical staff and all clinical groups involved; appeals admission denials with insurance payers; and provides clinical support to Clinical Documentation Integrity (CDI) staff.
The Physician Advisor will:
• Provide timely reviews and medical decision-making ensuring patients are in the appropriate level of care in compliance with governmental regulations, conditions of participation and commercial insurance contracts.
• Assist with the denial management/appeal process by engaging in insurance payer Peer-to-Peer discussions, and retrospective payer admission/DRG denials.
• Provide advice regarding resource management, including whether certain tests, procedures, or consultations could be safely and appropriately deferred to the outpatient setting.
• Provide feedback to attending and consulting physicians regarding level of care, length of stay, and throughput issues. Seeks additional clinical information from the attending and consulting physicians. Recommend and requests additional, more complete, medical record documentation.
• As needed, participates in the Utilization Review Committee.
• Provide clinical advice relative to coding inquiries for Clinical Documentation Integrity (CDI) staff. Assists in clarifying documentation in the medical record. Provides physician-to-physician contact for coding or clinical documentation issues.
• Provide guidance and expertise, when requested, in the evaluation of payer contracts.
Requirements:
• Licensed physician in the State of New Jersey; Board Certification desired.
• Minimum of five or more years of clinical practice in an acute care hospital setting.
• Excellent verbal, written and interpersonal communication skills.
• Ability to interact with the medical staff to obtain the buy-in and collaboration necessary to achieve desired outcomes.
Grade 138
