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Signature Healthcare Physician Advisor in Brockton, Massachusetts

The physician advisor will have experience with utilization management, will understand state and federal regulations, have knowledge about the denials and appeals process, and have experience with physician documentation and electronic health records. Approximately 80% of the physician advisor’s time will be dedicated to the care management functions with the remaining time split between clinical documentation improvement and medical informatics. The Physician Advisor (PA) conducts clinical reviews on cases referred by care management staff and/or other healthcare professionals to meet regulatory requirements and in accordance with the hospital objectives for assuring quality patient care and efficient utilization of health care services. The PA meets with care management and healthcare team members to discuss selected cases and make recommendations for care, interacting with the medical staff members and medical directors of third party payers to discuss the needs of patients and alternative levels of care. The PA acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources. The PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations.

As the CDI physician advisor, the PA will act as a liaison between the CDI professional, HIM, and the hospital’s medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, in addition to DRG assignment.

As the Medical Informatics physician advisor, the PA will act as a liaison between the electronic health record (EHR) implementation team and the medical staff ensuring that the system is optimized for effective physician use. The PA can help facilitate training for the physicians. Minimum of 4 years recent experience in clinical practice. Utilization management experience preferred.