CDIUM Physician Advisor Greater East Bay
CDIUM Physician Advisor Greater East Bay
Posted on :
22-04-2025
Employer Active
1 Vacancy
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Job Description
We are so glad you are interested in joining Sutter Health!
Organization:
SHSOSutter Health System OfficeBayPosition Overview:
The Physician Advisor (PA) is a key member of the hospitals leadership team charged with meeting the organizations goals and objectives for ensuring the effective efficient utilization of health care services. The PA will develop expertise on matters regarding physician practice patterns over and underutilization of resources medical necessity documentation best practices level of care progression denial management and compliance with governmental regulations and conditions of participation and commercial insurance contracts. The PA is responsible for establishing maintaining and strengthening the relationship with System Enterprise and the hospital to appropriately optimize the use of Sutter Health Internal Physician Advisor Services (IPAS). The physician Advisor will work closely with the medical staff including house staff and all utilization management (UM) personnel Care Management (CM) personnel to develop and implement methods and strategies to optimize the use of hospital services. This includes care management processes that ensure patients are in the appropriate level of care with supporting documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on cases referred by UM/CM staff and or other healthcare professionals to meet regulatory requirements in accordance with the hospital objectives for assuring quality patient care and effective efficient utilization of health care services. The PA meets with care management UM staff and health care team members and medical directors of thirdparty payers to discuss the needs of patients and alternative levels of care. The PA acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization continued stay and use of resources. The PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations. The PA will act as a liaison between the CDI (Clinical Documentation Improvement) professional HIM (Health Information Management and the hospitals medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data capture of severity acuity and risk for mortality in addition to Direct Report Groups (DRG) assignment.Job Description:
EDUCATION:
- Doctorate: Graduate of an accredited medical school
CERTIFICATION & LICENSURE:
- MDDoctor of Medicine OR DODoctor of Osteopathy
- Unrestricted medical license in state of residence
TYPICAL EXPERIENCE:
- 3 years of recent relevant experience.
SKILLS AND KNOWLEDGE:
- Excellent interpersonal communication and negotiation skills.
- A broad knowledge base of health care delivery and case management within a managed care environment.
- Comprehensive knowledge of Utilization Review levels of care and observation status.
- Some awareness of healthcare reimbursement systems: Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Patient Processing Service (PPS)Centers for Medicare and Medicaid Services (GR) Grouper (CMS) preferred.
- Postacute levels of care such as Home Health Hospice Advance Illness Management (AIM) and Palliative Care. Skilled Nursing Facility (SNF) Long Term Acute Care (LTAC) B&C Subacute Acute rehab.
- Proficient Knowledge of coding and DRG assignment process preferred.
- Must be able to effectively communicate with and promote cooperation and collaboration between individuals including patients/families/caretakers physicians nurses and other ancillary partners.
- Ability to work independently and exercise sound judgment in interactions with physicians payers and patients and their families.
- Demonstrates commitment to service excellence in all patient family and employee interactions and in performing all job responsibilities.
- Functions in a manner to promote quality patient care and assure a positive patient experience.
- Excellent verbal and written communication skills.
- Must have excellent time management skills to develop organized work processes in a highvolume environment with rapidly changing priorities.
- Intermediate computer skills.
- Ability to promote teamwork and to effectively function in teams.
- Ability to interact effectively with key internal and external constituents using collaboration and customer service skills that promote excellence in the patient experience.
Job Shift:
DaysSchedule:
Full TimeDays of the Week:
Monday FridayWeekend Requirements:
As Needed OccasionallyBenefits:
YesUnions:
NoPosition Status:
ExemptWeekly Hours:
40Employee Status:
RegularSutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $127.05 to $203.28 / hourThe salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidates experience education skills licensure and certifications department equity training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
Key Skills
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