Sys Physician Advisor I

at  CommonSpirit Health

Overview
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Responsibilities

REQUIRED EDUCATION AND EXPERIENCE

MD or DO required
Minimum of 1 year of experience as a Physician Advisor preferred.
Minimum of 5 years of clinical practice required.
Broad-based knowledge regarding clinical practice.
Broad knowledge base with trust and respect of medical staff physicians.
In-depth knowledge of CMS regulations, including understanding of the 2-midnight rule.
Utilization management experience.
Education in quality and utilization management through continuing medical education programs and self-study.
Knowledge of and practical use of good business English, spelling, arithmetic, practices and the ability to communicate effectively using written and verbal skills.
Pay Range
$75.64 - $109.67 /hou

• Conducts medical record review in appropriate cases for medical necessity of hospital admission, continued hospital stay, adequacy of discharge planning and quality care management.
• Understand the intricacies of the Medicare Inpatient Prospective Payment System (IPPS) to make medical determinations on severity of illness, acuity, risk of mortality, and communicate with treating physicians in cooperation with the utilization team and health information staff.
• Understand the intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG.
• Contacts Case and Utilization Management Teams: Makes telephonic/electronic contacts with case and utilization management to discuss clinical aspects of hospital encounters, as well as, medical necessity and appropriate levels of care.
• Contacts Attending Physicians: Makes telephonic/electronic contacts with Attending Physicians to discuss clinical aspects of hospital encounters, as well as, medical necessity and appropriate levels of care. Discussion may also include education for improved clinical documentation, in addition to, governmental and commercial guidelines for reimbursement.
• Conducts Peer to Peer discussions with payers as needed