Physician Advisor

Houston Methodist is seeking a Physician Advisor to join their team, focusing on teaching, consulting, and advising the case management department, clinical documentation specialists, medical staff, and the hospital on medical necessity, compliance, payer relationships, and resource utilization. This role is integral to the hospital's utilization review/management committee, ensuring high-quality healthcare and cost-effectiveness. The Physician Advisor will conduct clinical reviews to support hospital objectives related to patient care quality.

Practice Info

• Key member and leader of the hospital's utilization review/management committee
• Focus on regulatory goals of ensuring high levels of healthcare quality and acceptable levels of cost
• Conducts clinical reviews on cases referred by case management and/or other healthcare professionals

Responsibilities

• Interact with medical staff members to discuss patient needs and alternative levels of care
• Provide consultation to case management staff regarding complex clinical issues and advise on next steps
• Provide feedback to attending and consulting physicians regarding level of care, length of stay, and quality issues
• Chair the utilization review/management committee, actively participate in defining operational strategic objectives for the Utilization Management Program, and serve as the liaison to other medical staff committees
• Assist with the evaluation of the hospital's Utilization Management Program, including annual review and revision of the hospital's UR plan
• Act as consultant and resource to attending/responsible physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources in length of stay management
• Review medical records identified by case managers, or as requested by other members of the healthcare team, to assist with the identification and management of denials
• Provide ongoing education to physicians and other providers on the link between ICD-10 and clinical terminology to improve understanding of severity of illness, risk of mortality, and DRG assignments

Shift & Schedule

• Work Shift: 1 - Day

Requirements

• Graduate of accredited medical school
• Five years experience in clinical practice
• MD - Physician - State Licensure - Texas Department of Licensing and Regulation_PSV
• Unrestricted medical license in the State of Texas
• Demonstrates the skills and competencies necessary to safely perform the assigned job
• Sufficient proficiency in speaking, reading, and writing the English language
• Ability to effectively communicate with patients, physicians, family members and co-workers
• Ability to foster positive medical staff relations and work effectively with all healthcare disciplines
• Demonstrates understanding and knowledge of utilization management, clinical documentation, and state and federal healthcare regulations
• Active practitioner