Physician Advisor

CHRISTUS St. Michael hospital is seeking a dedicated Physician Advisor to serve its facilities and affiliates in a full-time administrative capacity. This role involves consulting, teaching, and advising the Care Management Department and medical staff on physician practice patterns, utilization review, and clinical documentation improvement. The successful candidate will enjoy a balanced schedule operating Monday through Friday with no call responsibilities. Reporting directly to the Chief Medical Officer, you will play a pivotal role in optimizing patient care levels, billing status, and regulatory compliance.

Practice Info

• Administrative physician role serving CHRISTUS St. Michael hospital and its affiliates
• Collaborates with the Care Management Department, CDI Departments, and medical staff

Responsibilities

• Lead the Utilization Review Committee in collaboration with the Director of CM
• Conduct secondary status reviews for appropriate level of care determination
• Conduct peer-to-peer consults with the payor medical directors for the denied cases to resolve medical necessity issues prior to claims submission
• Provide education to physicians and other clinicians related to regulatory requirements, appropriate billing status, and utilization of alternate levels of care
• Participate in daily IDRs and take action to expedite testing and treatment to promote efficient patient care and appropriate LOC
• Act as a liaison with payers to facilitate approvals and prevent denials or carved-out days when appropriate
• Review cases that indicate a need for issuance of a hospital notice of non-coverage determination
• Provide feedback to physicians in each service on clinical documentation using specific case examples/3M

Compensation

• Competitive compensation

Benefits

• Competitive benefits
• No state income tax
• Relocation assistance

Shift & Schedule

• Full-time
• M-F, no call responsibilities

Qualifications

• 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 an Utilization Management Committee
• Demonstrated cost-efficient practice