San Diego , California
Eau Claire, Wisconsin
Greater Milwaukee Area, Wisconsin
Posted: 11-Apr-25
Location: Longview, Texas
Categories:
Internal Number: 258415
CHRISTUS Good Shepherd Medical Center-Longview is a full-service, acute-care, 425-bed regional referral center, considered one of the region?s top Level III Trauma Centers.
The Physician Advisor reports to the Chief Medical Officer and serves as a resource to the utilization review and care management staff on medical necessity, level of care, patient care progression, and denial management. This physician leader will act as a consultant and resource to the medical staff regarding their decisions related to the appropriateness of hospitalization, continued stay, and appropriate use of resources.
Key Responsibilities:
- Conduct status reviews or secondary case reviews for individual patient cases or series of cases to assess the medical necessity of hospitalizations or services, determine the level of care and render a recommendation to the attending provider.
- Conduct peer-to-peer consults, or coordinate discussions with the payer medical directors for patient cases that have been denied, to resolve medical necessity issues prior to a claim submission.
- Meets the health system's objectives for assuring quality patient care and effective, efficient utilization of healthcare resources while also meeting regulatory requirements.
- Meets with care management and healthcare team members to discuss elective cases and make recommendations related to the appropriate level of care and care progression.
- Participate in case denial meetings to identify opportunities and decrease inappropriate denials
- Interacts with medical staff members and payer medical directors to discuss the needs of patients, access to care and alternative levels of care.
- Acts as consultant and resource to the CDI team for query facilitation.
- Acts as consultant and resource to the transfer center team for challenging case reviews
- Creates and presents analysis of short-term projects to explain claims and areas of opportunity to leadership and other associates
- Act as educated to different levels of staffing and ongoing basis
- Assist the System Medical Director for Physician Advisor services in achieving other goals like reducing avoidable length of stay, improving throughput and ensuring responsible stewardship of clinical resources
- Supports compliance with all state and federal regulations
Required Knowledge and Skills:
- Knowledge of CMS/commercial insurance rules and regulations regarding medical necessity and appropriate use of resources
- Strong organizational skills with attention to detail
- Excellent analytical and problem-solving skills
- Effective verbal and written communication skills
- Proven capability to communicate to develop positive relationships with medical staff, physicians, nurses, care managers and others
- Proficient technical skills, including electronic medical records and computer software skills
- Ability to understand, comply and advance CHRISTUS Health strategic priorities, commitments, and values
Required Qualifications:
- M.D. or DO degree from an accredited medical school.
- 5 years of experience in the clinical setting
- 2 years of experience in a physician advisor role or equivalent
- 2 years of experience in leadership and/or management roles
- Board-certified in a clinical specialty
- Board certification in HCQM (ABQAURP) preferred.
Highlights/ Benefits:
- Balanced professional and personal lifestyle
- Competitive compensation and benefits
- No state income tax
- Relocation assistance
Community Description:
- Easy drive to Dallas
- Enjoy the lush green countryside, pine tree-covered hills and lakes.
- Year-round outdoor activities include golfing, hunting, fishing, camping, hiking, and boating.
- Excellent public and private schools
Recruiter
Lorie Seals
Lorie.seals@christushealth.org
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