Physician Advisor-6027
Kingman Regional Medical Center, Kingman, AZ, United States
Job Description
Position Title:
Physician Advisor
Position Code:
PhyAdv-6027
Department:
Case Management
Oracle Title:
Physician Advisor-6027
Reports to:
Director
Safety Sensitive:
Yes
Exempt Status:
Yes
Position Purpose
All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.
Key Responsibilities
Perform timely and compliant medical necessity reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements and directly communicate any necessary updates.
Facilitate denial management through review of selected cases, conduct peer-to-peer discussions with third‑party payers as appropriate, and assist with appeals letters.
Work closely with hospital leadership, medical staff, and hospital ICM leaders to support system CPIs and initiatives.
Partner with hospital leadership, physician advisors, and corporate administration to standardize best practices in utilization management and care progression.
Conduct medical record review in cases in question for medical necessity of admission, need for continued hospital stay, adequacy of discharge planning, and quality care management.
Contact attending physicians and/or consultants as needed to seek clarification or additional information, documentation requirements, discuss alternate level of care options, minimize denials, relieve bed capacity constraints, and expedite care across the continuum.
Support case management department staff in clinical decisions, escalation of patient care issues, and management of long LOS patients.
Assist with level of care and length of stay management, denial management, review and suggest resource and service management, and assist staff with clinical review of patients to ensure professionally recognized standards of quality care are met.
Ensure compliance with CMS regulations, payer requirements, and internal policies related to utilization and medical necessity.
Perform other duties as assigned to support overall effectiveness of the department and organization.
Qualifications
Education:
Completion of Medical Doctorate or Doctor of Osteopathy degree from an accredited medical school.
Completion of an accredited residency training program.
Experience:
N/A
Certification:
Board certification in specialty required at time of hire.
License:
Active and unrestricted state of Arizona medical license.
Knowledge, Skills, and Abilities:
Possess or acquire a working knowledge of CMS regulatory guidance and requirements as they pertain to utilization and site of service decisions.
Possess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments.
Familiarity with standard published leveling criteria such as MCG/InterQual and ability to apply professional judgment and patient‑specific variables as may be necessary or justifiable.
Preferences
Education:
N/A
Experience:
Minimum of 5 years of clinical experience, hospital clinical experience.
Certification:
N/A
License:
N/A
Knowledge, Skills, and Abilities:
N/A
Special Position Requirements
Exposure Category III: Expected duties do not have potential for exposure to blood, body fluids or tissues.
Work Requirements
Ability to sit for 6-7 hours daily at a desk and/or computer terminal.
Acknowledgement
This job description applies to all KHI facilities and is representative of the essential job duties this position will perform. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
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Position Title:
Physician Advisor
Position Code:
PhyAdv-6027
Department:
Case Management
Oracle Title:
Physician Advisor-6027
Reports to:
Director
Safety Sensitive:
Yes
Exempt Status:
Yes
Position Purpose
All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.
Key Responsibilities
Perform timely and compliant medical necessity reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements and directly communicate any necessary updates.
Facilitate denial management through review of selected cases, conduct peer-to-peer discussions with third‑party payers as appropriate, and assist with appeals letters.
Work closely with hospital leadership, medical staff, and hospital ICM leaders to support system CPIs and initiatives.
Partner with hospital leadership, physician advisors, and corporate administration to standardize best practices in utilization management and care progression.
Conduct medical record review in cases in question for medical necessity of admission, need for continued hospital stay, adequacy of discharge planning, and quality care management.
Contact attending physicians and/or consultants as needed to seek clarification or additional information, documentation requirements, discuss alternate level of care options, minimize denials, relieve bed capacity constraints, and expedite care across the continuum.
Support case management department staff in clinical decisions, escalation of patient care issues, and management of long LOS patients.
Assist with level of care and length of stay management, denial management, review and suggest resource and service management, and assist staff with clinical review of patients to ensure professionally recognized standards of quality care are met.
Ensure compliance with CMS regulations, payer requirements, and internal policies related to utilization and medical necessity.
Perform other duties as assigned to support overall effectiveness of the department and organization.
Qualifications
Education:
Completion of Medical Doctorate or Doctor of Osteopathy degree from an accredited medical school.
Completion of an accredited residency training program.
Experience:
N/A
Certification:
Board certification in specialty required at time of hire.
License:
Active and unrestricted state of Arizona medical license.
Knowledge, Skills, and Abilities:
Possess or acquire a working knowledge of CMS regulatory guidance and requirements as they pertain to utilization and site of service decisions.
Possess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments.
Familiarity with standard published leveling criteria such as MCG/InterQual and ability to apply professional judgment and patient‑specific variables as may be necessary or justifiable.
Preferences
Education:
N/A
Experience:
Minimum of 5 years of clinical experience, hospital clinical experience.
Certification:
N/A
License:
N/A
Knowledge, Skills, and Abilities:
N/A
Special Position Requirements
Exposure Category III: Expected duties do not have potential for exposure to blood, body fluids or tissues.
Work Requirements
Ability to sit for 6-7 hours daily at a desk and/or computer terminal.
Acknowledgement
This job description applies to all KHI facilities and is representative of the essential job duties this position will perform. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
#J-18808-Ljbffr