PHYSICIAN ADVISOR - (FULL-TIME/ONSITE) WILLOWBROOK
Company: Houston Methodist
Location: Houston
Posted on: October 23, 2024
Job Description:
Overview
At Houston Methodist, the Physician Advisor is responsible for
teaching, consulting, and advising the case management department,
clinical documentation specialists, medical staff and the hospital
on matters regarding medical necessity; compliance rules and
regulations; collaboration and relationships with payers; physician
practice patterns; documentation and over- and under-utilization of
resources. The Physician is a key member and leader of the
hospital's utilization review/management committee, which is
charged with regulatory goals of ensuring high levels of healthcare
quality and acceptable levels of cost. The Physician Advisor will
conduct clinical reviews on cases referred by case management
and/or other healthcare professionals in accordance with hospital
objectives related to quality care of patients.
Houston Methodist Standard
PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental Scope of Service and Provision of Care plans,
as applicable, for description of primary age groups and
populations served by this job for the respective HM entity.
HOUSTON METHODIST EXPERIENCE EXPECTATIONS
- Provide personalized care and service by consistently
demonstrating our I CARE values:
- INTEGRITY: We are honest and ethical in all we say and do.
- COMPASSION: We embrace the whole person including emotional,
ethical, physical, and spiritual needs.
- ACCOUNTABILITY: We hold ourselves accountable for all our
actions.
- RESPECT: We treat every individual as a person of worth,
dignity, and value.
- EXCELLENCE: We strive to be the best at what we do and a model
for others to emulate.
- Practices the Caring and Serving Model
- Delivers personalized service using HM Service Standards
- Provides for exceptional patient/customer experiences by
following our Standards of Practice of always using Positive
Language (AIDET, Managing Up, Key Words)
- Intentionally collaborates with other healthcare professionals
involved in patients/customers or employees' experiential journeys
to ensure strong communication, ease of access to information, and
a seamless experience.
- Involves patients (customers) in shift/handoff reports by
enabling their participation in their plan of care as applicable to
the given job
- Displays cultural humility, diversity, equity and inclusion
principles
- Actively supports the organization's vision, fulfills the
mission and abides by the I CARE values Responsibilities
PEOPLE ESSENTIAL FUNCTIONS
- Interact with medical staff members to discuss needs of
patients and alternative levels of care. Provide consultation to
case management staff regarding complex clinical issues and advises
on next steps. Provide feedback to attending and consulting
physicians regarding level of care, length of stay, and quality
issues.
- Chair the utilization review/management committee, actively
participates in defining operational strategic objectives for the
Utilization Management Program and serve as the liaison to other
medical staff committees that interface with the utilization
review/management committee. Assist with the evaluation of the
hospital's Utilization Management Program, including annual review
and revision of the hospital's UR plan.
- Contacts physicians to resolve delays and achieve positive
outcomes and ensures physician accountability for efficient patient
care management. Communicates to medical staff leaders (e.g.,
department chairs, medical directors and other attending physicians
as necessary) relevant findings of physician's performance when
patterns of clinical outcomes demonstrate undesirable variation.
SERVICE ESSENTIAL FUNCTIONS
- Create strategies to enhance hospital and post-acute
interdisciplinary efforts for maximizing patients/family outcomes.
Serve as an advocate for case management services and clinical
documentation. Collaborate with medical staff in the development
and measurement of performance standards involving patient care and
utilizations of resources to achieve optimal outcomes.
- Round on the patient care units, and throughout the hospital,
to identify opportunities, to impact resource utilization and
manage length of stay (e.g., outliers, medical management
practices, problematic patient/family dynamics).
- Provides support and assists Clinical Documentation Specialists
and Coders on an ongoing basis by addressing specific documentation
issues encountered by CDSs/Coders, including noncompliant
physicians. Determines the -focus - of presentations of clinical
examples regarding documentation opportunities and specifics based
on quarterly trends and presents this information in department
meetings. QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Act as consultant and resource to attending/responsible
physicians regarding their decisions relative to appropriateness of
hospitalization, continued stay and use of resources in length of
stay management. Use InterQual criteria and document patient care
reviews, decisions, and other pertinent information per
hospital/case management and clinical documentation policies
policy.
- Review issues identified by case management department to
ensure appropriate follow-up, recommends improvement initiatives as
needed and makes referrals to appropriate department chairs as
necessary.
- Determine if standards of quality care, as defined by the
hospital's Medical Executive Committee are met.
- Seek additional clinical information from the attending and
consulting physicians as required to make effective level of care
determinations, and in doing so, recommends and requests
additional, or more complete, medical record documentation to
support such determinations. FINANCE ESSENTIAL FUNCTIONS
- Review medical records identified by case managers, or as
requested by other members of the healthcare team, in order to
assist with the identification and management of denials. Make
suggestions related to resource utilization and service management.
- Actively participate in the hospital's claim denial process,
including, but not limited to, responding to denials from payers on
a concurrent basis; authoring denial letters as needed on
retrospective denials; and determining to what extent denied cases
will be appealed. Review cases that indicate need for issuance of a
-hospital notice of non-coverage -. GROWTH/INNOVATION ESSENTIAL
FUNCTIONS
- Maintain knowledge of current state, federal, and CMS
regulations, DNV requirements, and guidelines on case management,
utilization review, and clinical documentation.
- Provide ongoing education to physicians and other providers on
the link between ICD-10 and clinical terminology to improve
understanding of severity of illness, risk of mortality and DRG
assignments of their individual patient records, as these relate to
individual physician/provider scorecards and collective (e.g.
division, department, entity specific) quality profiling and
reimbursement. Education may include department or division
meetings, individual provider meetings, articles in entity-specific
newsletters and other communication vehicles as
identified/developed.
- Provides education to physicians and other clinicians related
to regulatory requirements, appropriate utilization of alternate
levels of care and community resources. Works with physicians to
facilitate referrals across the continuum of care. Facilitates,
mentors, educates other physicians regarding payor requirements and
lnterQual Criteria and CMS guidelines for medical necessity.
This job description is not intended to be all-inclusive; the
employee will also perform other reasonably related business/job
duties as assigned. Houston Methodist reserves the right to revise
job duties and responsibilities as the need arises.
Qualifications
EDUCATION
- Graduate of accredited medical school WORK EXPERIENCE
- Five years recent experience in clinical practice.
License/Certification
LICENSES AND CERTIFICATIONS - REQUIRED
- MD - Physician - State Licensure - Unrestricted medical license
in the State of Texas AND
- Active practitioner KSA/ Supplemental Data
KNOWLEDGE, SKILLS, AND ABILITIES
- Demonstrates the skills and competencies necessary to safely
perform the assigned job, determined through on-going skills,
competency assessments, and performance evaluations
- Sufficient proficiency in speaking, reading, and writing the
English language necessary to perform the essential functions of
this job, especially with regard to activities impacting patient or
employee safety or security
- Ability to effectively communicate with patients, physicians,
family members and co-workers in a manner consistent with a
customer service focus and application of positive language
principles
- Ability to foster positive medical staff relations and work
effectively with all healthcare disciplines.
- Demonstrates understanding and knowledge of utilization
management, clinical documentation, and state and federal
healthcare regulations. SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs Yes
- Business professional Yes
- Other (department approved) No ON-CALL*
*Note that employees may be required to be on-call during
emergencies (ie. DIsaster, Severe Weather Events, etc) regardless
of selection below.
- On Call* No TRAVEL**
**Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area
Yes
- May require travel outside Houston Metropolitan area No
Company Profile
Houston Methodist Willowbrook Hospital opened in December 2000 to
serve the comprehensive health care needs of the growing community
in Northwest Houston. The 310 bed hospital has 23 operating rooms,
and more than 2,100 employees. Houston Methodist Willowbrook
Hospital has been named a Magnet recognized health care facility by
the American Nurses Credentialing Center's (ANCC) Magnet
Recognition Program -. Houston Methodist Willowbrook Hospital is
Northwest Houston's regional leader in robotic minimally-invasive
surgeries and specializes in cardiology and cardiovascular
services, neurology, neurosurgery, orthopedics and sports medicine,
and comprehensive cancer services. Houston Methodist Willowbrook
Hospital has a Breast Care Center, Cancer Center, Imaging Center,
Infusion Center, Sleep Center, Surgical Weight Loss Center and
operates the largest Childbirth Center in the greater Northwest
Houston area.
Keywords: Houston Methodist, League City , PHYSICIAN ADVISOR - (FULL-TIME/ONSITE) WILLOWBROOK, Healthcare , Houston, Texas
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