Hospital based Physician advisors are employed by Hospital systems and perform a wide range of functions.
These roles may be Onsite-hospital based or Part Remote.
Here is a job posting for an Onsite Physician Advisor:
Physician advisor is a broad role, encompassing various areas of healthcare quality and management.
There are many reasons why Physician advisors are needed
regulatory oversight
policy change
cost containment
Medicare audit and denial,
commercial insurance denial,
mental state management
clinical documentation improvement,
quality outcomes
patient safety,
ICD 10 implementation.
The rising healthcare costs necessitate that the business of medicine have a physician voice in it.
The COVID Pandemic has increased the pressure on hospitals to control costs.
Hospital administrators alone are simply not equipped to answer all questions that require input from a clinical perspective.
The documentation and reimbursement in hospital settings are also complex subjects, physicians have an edge because they are well versed in medicine, familiar with CMS regulation, have to bill and code and work closely with case management.
Add leadership responsibilities as physicians already engage other colleagues, by providing them support and directing with them on a regular basis. It is important these days that the care we provide is effective, efficient, quality and safe.
And who better than a physician to make sure that these are done in an evidence based manner combining clinical expertise and patient advocacy at times.
Here is another example of a job posting for an Onsite Physician Advisor:
Transferable skills for Hospital based Physician Advisors include:
Perform Concurrent admission review
Participation in daily multidisciplinary rounds
Involvement in patient quality and safety initiatives
Provide physician education.
Providing support to case management team
Dealing with medical necessity issues
Denial management with case management
Rounding with case management to discuss discharge planning and transition of care to SNF or other facilities
Reviewing medical records
Hospital based documentation improvement initiatives
Patient status designation and dealing with coding related queries
Participation in ICD 10 roll out
UM committee involvement or leadership experience
Involvement in appeal of denials
Participation in coding audit
Discussing medical necessity for patient services
Quality and performance committee involvement
Participation in performance imp activities
Involvement in Med staff
Working closely with nursing and other ancillary staff
Provide clinical perspective at hospital board
Manage patient flow through the several healthcare systems and processes
Participate in Family meetings
Supervise appeal writing
Peer to peer discussions
Educate other professionals about patient status
Educate med staff on coder concerns and study coding patterns
Improve query response rate
Oversee Revenue cycle
Ensure credible documentation
Educate nurses
Guidelines followed in hospital setting
Interqual
MCG
Responsibilities of a Physician Advisor:
Provides medical oversight of clinical documentation and participates in clinical documentation improvement initiatives
Provides education to medical staff and bridges the gap between providers and hospital administration
Conducts clinical reviews while working closely with case management
Participates in Discharge planning rounds
Participates in quality initiatives
Ensures safe patient care
Guides level of care decisions
Monitors utilization of diagnostic services
Helps maintain compliance with regulatory oversight
Qualifications needed to be a Physician advisor
A varying mix of following qualifications might be needed
5 years of clinical experience
Board certification in primary specialty
Licensed to practice medicine
Interest in UM
Further education:
A few programs offer extra credentials.
For example ABQUARP offers HCQM certification exam which can help gain more knowledge and a credential of a board certified Physician Advisor
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