Onsite Physician Advisor - Texarkana

The Physician Advisor is a full-time administrative physician role serving CHRISTUS St. Michael hospital and its affiliates through teaching, consulting, and advising both the Care Management Department and the medical staff on matters regarding physician practice patterns, documentation, resource utilization, medical necessity, compliance, payer relationships, and community engagement. The PA supports and executes initiatives in the Care Management and CDI Departments by promoting effective physician documentation to support patients' Level of Care (LOC), billing, and MS-DRG/DRG assignment.

The PA will submit monthly time records for their responsibilities. M-F, with no call duties.

The PA reports directly to the Chief Medical Officer of St. Michael hospital - Texarkana.

The Physician Advisor role requires a physician with:

• 5 years of clinical experience
• Licensed in the state of residence
• Board certified in a clinical specialty
• American Board of Quality Assurance and Utilization Review Physicians, Inc (ABQUARP) certification - preferred
• Experience in clinical practice and utilization review
• Served on or chaired an Utilization Management Committee
• Demonstrated cost-efficient practice

• Lead the Utilization Review Committee in collaboration with the Director of CM
• Conduct secondary status reviews for appropriate level of care
• Perform peer-to-peer consults with payor medical directors on denied cases
• Monitor key metrics like denial trends, length of stay, and Condition Code 44, and participate in improvement actions

• Educate physicians and clinicians on regulatory requirements, billing, utilization, community resources, and end-of-life care
• Facilitate referrals to care continuum
• Mentor physicians on payer requirements and clinical documentation
• Coach UR Case Managers to improve care progression knowledge

• Participate in daily IDRs to expedite testing and treatment
• Guide ED physicians and CM staff on LOC designation at intake
• Act as liaison with payers for approvals and denials
• Review long-stay cases and hospital notices of non-coverage
• Document reviews and decisions per hospital policy
• Have foundational knowledge of Inter Qual and MCG criteria
• Participate in leadership and staff meetings to advance departmental goals
• Report conflicts of interest in patient reviews

• Provide feedback to physicians on clinical documentation with case examples

• Balanced professional and personal lifestyle
• Competitive compensation and benefits
• No state income tax
• Relocation assistance

• Easy drive to Dallas
• Enjoy green countryside, pine hills, lakes
• Outdoor activities: golf, hunting, fishing, camping, hiking, boating
• Excellent schools

Liz Flippo

Email: liz.flippo

More info: https://(Use the "Apply for this Job" box below). Your Rights
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