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The Physician Advisor (PA) conducts clinical reviews on cases referred by data quality staff, care management staff, and/or other health care professionals to meet regulatory requirements and in accordance with the organization’s objectives for assuring quality patient care, effective & efficient utilization of health care services and proper assignment of ICD-10 codes/DRG. The PA meets with data quality, care management, and other health care team members to discuss selected cases and make recommendations on the next line of action. They will interact with medical staff members and medical directors of third-party payers to discuss medical necessity determinations and appropriateness of assigned DRGs for inpatient encounters. The PA acts as consultant to and as a 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 & state utilization, quality regulations, peer to peer reviews, documentation consistency, DRG downgrade denials and applicable physician education. The PA works with the EMR team ensuring that the system is optimized for effective and efficient physician use. They will facilitate physician education to ensure accurate and complete documentation for coding and DRG assignment. They will perform other duties as assigned or required.

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1.    Graduate of an accredited medical school.

2.    Minimum of 3 years’ experience in clinical practice or teaching capacity.

3.    Licensed physician in California

Preferred qualifications:

1.    Prior Physician Advisor Experience desired

2.    Additional education/training in CDI, coding, quality and utilization management. 

3.    Excellent written and verbal communication skills.

4.    Excellent interpersonal skills to build effective partnering relationships with physicians, nursing staff and hospital management staff.

5.    Ability to work independently in a time-oriented environment.

6.    Computer literacy and familiarity with the operation of basic office equipment.