Physician Advisor

job
  • CHRISTUS St. Frances Cabrini Hospital
Job Summary
Location
Alexandria ,LA 71302
Job Type
Contract
Visa
Any Valid Visa
Salary
PayRate
Qualification
BCA
Experience
2Years - 10Years
Posted
02 Jan 2025
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Job Description

Key Responsibilities:


1. Clinical Documentation Improvement (CDI):

  • Collaborate with clinical teams and CDI staff to ensure accurate, complete, and compliant documentation of patient care.
  • Conduct clinical reviews of medical records to verify that documentation accurately reflects the patient’s severity of illness, risk of mortality, and clinical outcomes.
  • Educate healthcare providers on best practices for clinical documentation to support quality metrics and reimbursement.
  • This role is also open to clinical time.


2. Utilization Management:

  • Evaluate and approve medical necessity and level-of-care decisions, supporting appropriate use of hospital resources.
  • Review admissions, continued stays, and discharge criteria for adherence to guidelines and policies.
  • Provide guidance on case management and patient flow to improve efficiency and resource allocation.


3. Compliance and Regulatory Support:

  • Ensure compliance with state, federal, and payer regulations, including Medicare and Medicaid guidelines.
  • Collaborate with compliance and quality teams to identify areas of risk and implement corrective actions.
  • Act as a resource for internal audits, denials management, and appeals related to medical necessity and documentation issues.


4. Physician Education and Communication:

  • Offer education sessions for medical staff on topics such as CDI, coding, utilization review, and regulatory compliance.
  • Serve as a liaison between physicians and administrative teams to foster understanding and alignment with policies and practices.
  • Address physician concerns related to documentation, utilization management, and regulatory requirements.


5. Quality Improvement Initiatives:

  • Participate in quality improvement and performance management programs aimed at enhancing patient outcomes.
  • Assist in analyzing data to identify trends, areas for improvement, and opportunities to optimize care quality.
  • Support initiatives related to value-based care and accountable care organizations (ACOs) by providing clinical insights.


6. Denial Management and Appeals Support:

  • Review cases with potential for claim denials and support appeals as necessary, working closely with revenue cycle and appeals teams.
  • Provide clinical expertise in managing denied claims to reduce financial risk and recover lost revenue.


Job Requirements


  • 5 years of clinical experience
  • Licensed physician in state of residence
  • Board certified in a clinical specialty
  • Certified by the American Board of Quality Assurance and Utilization Review Physicians, Inc (ABQUARP) - preferred
  • Experienced in clinical practice with an understanding of utilization review
  • Served on or chaired a Utilization Management Committee
  • Demonstrated cost-efficient practice
  • Clinical time, if desired, is flexible and negotiable.


Please send your CV to

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