CDI Physician Advisor, Greater Silicon Valley and San Francisco Division
CDI Physician Advisor, Greater Silicon Valley and San Francisco Division
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$ 127 - 203
1 Vacancy
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.This is a hybrid role with some onsite requirements in the dedicated area.
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:
Quality Management & Performance Improvement:
Effectively leads change in behavior on the documentation needs of the medical staff and other clinical providers to achieve organizational objectives related to quality improvement and revenue cycle initiatives
Assists with the creation and implementation of documentation strategies for accurate and complete reflection of the quality of care
Applies knowledge of coding rules and regulations along with understanding of risk adjustment and quality reporting methodology to achieve organizational goals
Elicits optimal value from documentation as a marker of quality of care
Operations:
Reviews cases escalated by CDI team for potential documentation opportunities
Participates in unanswered query escalation process by following up with physicians electronically and inperson to obtain query responses
Meets regularly with CDI Director CDI Managers and CDI Leads to understand current areas of opportunity and discuss unanswered queries
Provides clinical feedback and provider perspective to CDI team to build credibility of the program and CDI staff
Partners in the development coordination and presentation of provider education:
- Focused on improving the accuracy of documentation and the reflection of the quality of patient care reported expected mortality expected length of stay medical necessity and other documentation related outcomes.
- Shares key clinical documentation concepts and their importance for hospital and individual providers
- Tailors education content and messaging to specific provider groups and specialties
Collaborates with subspecialty providers to create consistent definitions and documentation around complex conditions
Develops and participates in recognition process for providers that have made significant positive impacts to the program
Helps to develop clinically appropriate and compliant provider queries to clarify documentation
Evaluates current documentation systems tools and processes and recommends innovative initiatives and improvements
Provides guidance and coaching to providers on how to use updated functionality effectively
Leads multidisciplinary and multidepartmental provider engagement strategies related to CDI strategic goals and objectives
Involved in Clinical Documentation Integrity Steering Committee and Quality Committees as appropriate
Communication:
Serves as liaison for providers and CDI team to address issues and questions
Proactively manages each groups perspectives and facilitates a collaborative relationship among stakeholders
Holds oneonone meetings with physicians to address areas of opportunity and respond to questions
Identifies preferred methods of communication for individual providers and/or provider groups
Quality Financial and Data Management:
Regularly reviews key process and outcomes metrics related to the CDI program:
- Process metrics: provider response rates agree rates response times query trends among others
- Outcomes metrics: medical and surgical capture rates capture rates by service line capture rates by DRG triplets and pairs case mix index expected mortality observed to expected mortality ratio CMS Star ranking Vizient rankings and risk variable capture Leapfrog rating among others
Develops action plans for nonresponsive providers providers with high disagreement and service lines with risk variable capture opportunity
Reports performance data and significant issues to senior leadership
Job Shift:
DaysSchedule:
Part TimeDays of the Week:
Monday FridayWeekend Requirements:
As NeededBenefits:
YesUnions:
NoPosition Status:
ExemptWeekly Hours:
20Employee 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
Part-Time
