Senior Physician Advisor

Job Number:

31672

Location:

Phoebe Putney Memorial Hospital

Street Address:

417 W 3rd Ave

City, State:

Albany, Georgia

Zip Code:

31701

Department:

PPMH CARE MANAGEMENT

Shift:

Job Type:

Full time

Posted Date:

2025-04-22

Job Description Summary:

The Senior Physician Advisor is a key member of the healthcare organization’s leadership team and is responsible for meeting the organization’s goals and objectives by facilitating accurate and complete documentation. The Senior Physician Advisor is a physician serving the hospital and medical staff through teaching and advising the medical staff, hospital leadership, and health information management and clinical documentation improvement departments. The Senior Physician Advisor shall develop expertise on matters regarding documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, safety and quality measures (PSI documentation and coding), and DRG assignment. The Senior Physician Advisor will provide support to the Revenue Cycle VP and System Director of Health Information Management and Clinical Documentation Improvement Functions in meeting the organizational strategic imperatives, goals, and operations.

Description:

Doctorate Degree in Medical Field (Required)

• Possess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, clinical documentation improvement, and patient safety. (Required)
• Possess a working knowledge of Phoebe Health System organization & case management operations and administrative standards and policies. (Required)
• Strong computer skills and working knowledge of the EMR. (Required)
• Familiarity with MCG Interqual placement status criteria (Preferred)
• Member of the American College of Physician Advisors (ACPA) (Preferred)
• Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) (Preferred)
• Ability to build rapport with medical staff and hospital leadership to obtain the buy-in and collaboration necessary to achieve desired outcomes (Required)
• Ability to provide medical guidance and support to the VP of Patient Logistics and Care Coordination as well as the Director(s) of Care Management and Phoebe Care Command in meeting operational goals and strategic imperatives. (Required)

Licenses and Certifications
Required Certifications Licensures: Medical Degree (Required)

Certified Clinical Documentation Specialist (CCDS) (Preferred)

ACUTE CARE FUNCTIONS:

• Review medical records of patients identified by case managers or as requested by the healthcare team in order to perform quality and utilization oversight
• Provide guidance to ED physicians and ED Case Management regarding status issues and alternatives to acute care when acute care is not warranted
• Perform medical necessity reviews including initial level of care, secondary reviews, and continued stay reviews
• Recommend and request additional and more complete medical record documentation to support placement status or medical necessity
• Facilitate, mentor, and educate other physicians regarding payer requirements.
• Provide regular feedback to physicians and all other stakeholders regarding the level of care, length of stay, and utilization of resources.
• Review cases that indicate a need for issuance of a hospital notice of non-coverage Important Message from Medicare (HINN). Discuss the case with the attending physician and if additional clinical information is not available, coordinate the process with the Care Manager for issuance of HINNs.
• Participate in the review of long-stay patients, in conjunction with the Care Management Leadership, Care Management team, and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care.
• Act as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate by participating in Peer to Peer discussions and reviews concurrently and retrospectively.
• Assist with the denial management process.
• Participate in all organizational efforts to reduce inappropriate readmissions.
• Understand and use MCG InterQual and other appropriate criteria.
• Document response to case management referrals. Support Case Management in a data-driven approach.
• Facilitate pre-payment reviews and or participate in recovery audit contractor reviews.
• Assist Hospital Administration and the Medical Staff in connection with any regulatory audits, investigations, surveys, or other reviews of t