PT Physician Advisor

Job Summary: The Physician Advisor serves as a liaison for Hospital Administration, the Department of Case Management and the Medical Staff regarding issues of resource and quality improvement. This job is also responsible for assisting with the actions necessary to address patient-specific quality/resource management issues. The Physician Advisor is responsible and accountable for reviewing cases referred by the Inpatient Case Management Department staff, interacting with members of the medical staff for educational purposes and facilitating compliance with the hospital's Utilization Plan and established Case Management processes. Essential Job Functions Accountabilities: Reviews individual cases, including denied cases, to evaluate appropriateness of admission or continuing stay, applying professional judgment in the context of patient-specific variables. Supports the Case Management department by reviewing and signing medical necessity appeal letters based on appropriateness of level of care. Communicates with attending physicians, residents and other health professionals as needed in order to clarify issues regarding appropriateness of level of care and resource utilization, including criteria for continued stay in specialty units. Acts as spokesperson for medical management activities in coordination with Medical Staff and Hospital leadership. Provides education and serves as a resource to medical staff colleagues regarding best practices, care management structures and functions, use of clinical guidelines and alternative levels of care. Analyzes data and presents to medical staff, individually and in meetings. Participates in clinical process redesign and implementation (clinical pathway/algorithm development, pre-printed order sheets, standing order sets, and clinical program development.) Supports implementation of system-wide clinical initiatives and participates in identification of opportunities, and development and implementation of clinical practice standards for the District. Assists in identifying avoidable days and resource use opportunities and addresses these issues with individual physicians and/or practice leaders. Coordinates and recommends approach to communicating medical management initiatives. Reviews reports and performance measures and makes recommendations to Departments and the Medical Executive Committee regarding opportunities for improvement in patient care, clinical documentation practices, resource utilization and reduction of denials. Provides input for design and implementation of automated information systems to improve clinical care coordination, e.g. order entry. Assists Clinical Documentation Specialists with physician communication and education relative to clinical documentation practices. Job description is not an all-inclusive list of duties and may be subject to change with or without notice. Staff are expected to perform other duties as assigned.