The Physician Advisor (PA) conducts clinical reviews on cases referred by data quality staff, care management staff, and/or other health care professionals to meet regulatory requirements and in accordance with the organization’s objectives for assuring quality patient care, effective & efficient utilization of health care services and proper assignment of ICD-10 codes/DRG. The PA meets with data quality, care management, and other health care team members to discuss selected cases and make recommendations on the next line of action. They will interact with medical staff members and medical directors of third-party payers to discuss medical necessity determinations and appropriateness of assigned DRGs for inpatient encounters. The PA acts as consultant to and as a resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources. The PA further acts as a resource for the medical staff regarding federal & state utilization, quality regulations, peer to peer reviews, documentation consistency, DRG downgrade denials and applicable physician education. The PA works with the EMR team ensuring that the system is optimized for effective and efficient physician use. They will facilitate physician education to ensure accurate and complete documentation for coding and DRG assignment. They will perform other duties as assigned or required.
EDUCATION, EXPERIENCE, TRAINING
Required qualifications:
1. Graduate of an accredited medical school.
2. Minimum of 3 years’ experience in clinical practice or teaching capacity.
3. Licensed physician in state.
Preferred qualifications:
1. Prior Physician Advisor Experience desired
2. Additional education/training in CDI, coding, quality, and utilization management.
3. Excellent written and verbal communication skills.
4. Excellent interpersonal skills to build effective partnering relationships with physicians, nursing staff and hospital management staff.
5. Ability to work independently in a time-oriented environment.
6. Computer literacy and familiarity with the operation of basic office equipment.
Resurrection Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $XXX,XXX.XX to $XXX,XXX.XX on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/
Part Time < 60
Days
Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
About Prime Healthcare and Prime Healthcare Foundation: Prime Healthcare is an award-winning health system operating 51 hospitals and more than 360 outpatient locations in 14 states, providing over 2.5 million patient visits annually. It is one of the nation's leading health systems, with nearly 57,000 employees and affiliated physicians. Eighteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Based in Ontario, California, Prime Healthcare is nationally recognized for award-winning quality care and has been named a 10 Top and 15 Top Health System by Truven Health Analytics. Its hospitals have been named among the nation's "100 Top Hospitals" 69 times and have received more Patient Safety Excellence Awards from Healthgrades than any other health system in the past eight years. To learn more, please visit primehealthcare.com.
