HonorHealth
Overview
HonorHealth is seeking a Physician Advisor (PA) to join a multidisciplinary team focused on utilization management, quality improvement, and collaboration with case management, physicians, and payers. This role involves clinical reviews, guidance on appropriate levels of care, documentation initiatives, and education for physicians to support optimal reimbursement and patient care. HonorHealth offers a diverse benefits portfolio for full-time and part-time team members. Learn more at honorhealth.com/benefits.
Responsibilities
Job Summary:
Serve as a liaison between hospital administration, physicians, payers, and case management to ensure appropriate utilization of resources and delivery of quality patient care. Conduct clinical reviews for regulatory compliance and hospital objectives; discuss cases with care teams; advise on level of care, length of stay, and resource use. Act as a CDI liaison for accurate documentation and DRG assignment. Coordinate with EHR implementation teams to optimize physician use. Support physician training and ensure clear, consistent communication. Medical Record Review:
Review medical records for medical necessity of admission, continued stay, discharge planning, and quality care. Maintain physician database prospect list. Communicate with attending physicians and consultants to clarify documentation, discuss alternative care options, minimize denials, and expedite care. Advise on non-coverage letters when appropriate. Case Management Support:
Assist with clinical decisions, escalation of care issues, LOS management, and denial management. Develop and communicate physician profiles to improve clinical practice. Review records to assess level of care, length of stay, and quality concerns; provide feedback to physicians; request additional documentation as needed; coordinate next steps in care and evidence-based indicators. Review long-stay cases with care management leadership and multidisciplinary teams to ensure appropriate care and avoid readmissions. Physician Engagement:
Contact and educate attending physicians and groups about referral services, new products, and case management guidelines. Support development of physician education plans for knowledge of case management and denial strategies. Payer and Compliance:
Conduct peer-to-peer negotiations with payers; intervene with physicians and managed care medical directors to address denials and improve reimbursement. Liaise with HIM and Denial Management to ensure complete documentation and coding accuracy. Participate in utilization management committees and compliance activities, including RAC reviews. Other:
Attend Joint Operation Committee (JOC) meetings as requested; participate in process improvement and utilization management initiatives. Facilitate transfers and coordinate care across care settings as needed. Education M.D. or D.O. Board Certified Physician with a special interest in Utilization Management & Quality Improvement (required) Graduates of an accredited medical school (required) Experience 5 years of recent clinical practice (required) Licenses and Certifications Physician – State Licensure (preferred) Physician ABIM/ABMS board certification (preferred) Seniority level Mid-Senior level Employment type Full-time Job function Health Care Provider Industries Hospitals and Health Care
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Serve as a liaison between hospital administration, physicians, payers, and case management to ensure appropriate utilization of resources and delivery of quality patient care. Conduct clinical reviews for regulatory compliance and hospital objectives; discuss cases with care teams; advise on level of care, length of stay, and resource use. Act as a CDI liaison for accurate documentation and DRG assignment. Coordinate with EHR implementation teams to optimize physician use. Support physician training and ensure clear, consistent communication. Medical Record Review:
Review medical records for medical necessity of admission, continued stay, discharge planning, and quality care. Maintain physician database prospect list. Communicate with attending physicians and consultants to clarify documentation, discuss alternative care options, minimize denials, and expedite care. Advise on non-coverage letters when appropriate. Case Management Support:
Assist with clinical decisions, escalation of care issues, LOS management, and denial management. Develop and communicate physician profiles to improve clinical practice. Review records to assess level of care, length of stay, and quality concerns; provide feedback to physicians; request additional documentation as needed; coordinate next steps in care and evidence-based indicators. Review long-stay cases with care management leadership and multidisciplinary teams to ensure appropriate care and avoid readmissions. Physician Engagement:
Contact and educate attending physicians and groups about referral services, new products, and case management guidelines. Support development of physician education plans for knowledge of case management and denial strategies. Payer and Compliance:
Conduct peer-to-peer negotiations with payers; intervene with physicians and managed care medical directors to address denials and improve reimbursement. Liaise with HIM and Denial Management to ensure complete documentation and coding accuracy. Participate in utilization management committees and compliance activities, including RAC reviews. Other:
Attend Joint Operation Committee (JOC) meetings as requested; participate in process improvement and utilization management initiatives. Facilitate transfers and coordinate care across care settings as needed. Education M.D. or D.O. Board Certified Physician with a special interest in Utilization Management & Quality Improvement (required) Graduates of an accredited medical school (required) Experience 5 years of recent clinical practice (required) Licenses and Certifications Physician – State Licensure (preferred) Physician ABIM/ABMS board certification (preferred) Seniority level Mid-Senior level Employment type Full-time Job function Health Care Provider Industries Hospitals and Health Care
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