The Physician Advisor (PAd) plays an important role in ensuring physician support and execution of for Utilization Management and Documentation strategies and processes.
Coding and Documentation Improvement (CDI) and Denial and Appeal (D&A) Management
- Promotion of effective and efficient physician documentation to support appropriate MS-DRG/DRG assignment and other coded documentation elements (POA, HAC, ROM, SOI, etc.) that affect the proper classification of the patient’s clinical situation and care.
- Providing clinical guidance, education and support to providers and the CDI/Coding team in situations where there may be the need for additional discussion and support for those cases where the CDI or HIM coding associates disagree regarding final MS-DRG/DRG assignment.
- Engage with providers to facilitate unanswered/disagreed CDI/Coding queries based on individual care merit
- Providing clinical guidance, education and support to providers and the D&A team in cases where documentation appropriateness of diagnoses or medical necessity of services are challenged or denied (by payors or in internal or external audits). This includes writing up appeals.
- Participation in physician educational in-services, in collaboration with UMD-Liaisons of provider groups assigned to the PAd (based on clinical competence area). Provide guidance and support to the UMD teams (CM, CDI, D&A) with the development of materials that may be utilized as physician education tools. Education shall address clinical content issues, UMD process issues, change management, etc.
- Participating in metrics development regarding providers’ UMD activities. Providing feedback based on these metrics to providers of the groups assigned to the PAd based on clinical competence area, in collaboration with respective UMD-Liaisons.
Providing cross coverage to other PAd-s (and their respective provider groups) in their absence for above activities as needed.
Level of Care (LOC) and Medical Necessity Management
- Promotion of effective and efficient physician documentation to support appropriate Level of Care (Inpatient vs. Observation, etc.) for patients in acute / hospital settings.
- Participate in education, metric development and feedback regarding LOC issues
- Case-by-case concurrent LOC support (to providers and CM-s)
- Actively lead and/or participate in educational and/or multidisciplinary rounds with UMD teams and clinical personnel
- Actively engage and intervene with attending physicians when concurrent or retrospective review identifies a documentation issue by any of the UMD teams
- Attend UMD and PAd meetings and support the Lead PAd in internal educational and quality assurance initiatives, including practice case reviews, etc.
- Actively engage in PAd and UMD program and process development
Develop and maintain skills in the areas of CDI, coding, LOC regulations, D&A processes, and other areas depending on the evolving strategies of the PAd and UMD programs.
- Medical Provider Licensed and practicing in NYS (MD, DO, NP, PA, or equivalent)
- Practice clinical medicine at least 20% of time
- Demonstrated skills and interest in CDI and/or LOC management
- High level of collaboration and inter-disciplinary skills needed to accomplish complex activities
- Ability to influence, negotiate and motivate collaborators
- Must be able to positively communicate and work with professionals at all levels of the organization
- Able to play a dynamic role with ability to adapt to constant change as the organizations needs change.
- Rochester was ranked the 3rd best place to live in New York and as the 26th best place to live among the 150 most populous metro areas in the United States by U.S. News and World Report.
- The Rochester area boast an affordable cost of living and nationally ranked public school districts
- Paid malpractice with full coverage + tail
- Defined Pension Plan with 5-year vestment period
- Full benefits package
- Multiple health insurance plans to choose from
In addition to the base pay range, certain provider positions may be eligible for variable compensation in accordance with health system pay practices. This may include: productivity and/or value based clinical incentives, bonus compensation, or other forms of variable pay.
PHYSICAL REQUIREMENTS L - Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly; requires occasional walking, standing or squatting.
LICENSES/CERTIFICATIONS Physician - New York State Education Department (NYSED)
Pay Range $250,000.00 - $300,000.00
The listed base pay range is a good faith representation of current potential base pay for successful applicants. It may be modified in the future. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.