Physician Advisor - PROF: QI / RISK MANAGEMENT

Title/Unit:
Physician Advisor

Shift/Schedule:
Full-time

Job Summary:
The Physician Advisor reviews cases referred by hospital personnel. A review consists of medical records review and attending physician contact as needed. Documentation will be maintained and kept secure in the Case Management office. Must be very well versed in InterQual Criteria. Identified quality of care issues will be referred to the appropriate quality committee: i.e. Medical Exec. Surgical Exec. Promotes Medicare, Medicaid and managed care compliance with appropriate regulations as they pertain to utilization issues. Reviews all potential Code 44's and completes the order forms. Reviews all Medicare 1 and 2 day LOS for appropriate billing status. Well versed in the HINN letter process. Monitors physician compliance to assure proper documentation in the Medical Records to reflect the treatment plan and care given to the patient. Address issues through medical staff in-services. Intervenes as needed regarding under/over utilization issues. Shall orient physicians new to the hospital staff to the Case Management process addressing concerns with regard to appropriateness issues, resource utilization, early discharge planning, use of InterQual criteria. Complies with all hospital and department policies regarding documentation requirements, including approved abbreviations, forms, computer access, and authentication of medical record entries. Rounds when possible at a time when physicians are "in house". Assist Case Management with QIO activities as needed.

Requirements:

• Florida Medical License (MD) required
• Must have experience in Case Management (inpatient/outpatient)
• Must have experience in using InterQual criteria
• Ability to analyze and interpret medical data/charts
• Ability to communicate effectively in writing, and verbally

*Not accepting vendor candidates for this position.