Health eCareers
Roles and Responsibilities Overview
The Physician Advisor (PA) is a full‑time administrative physician serving CHRISTUS St. Michael Hospital and its affiliates. The PA teaches, consults, and advises the Care Management Department and the medical staff on physician practice patterns, documentation, utilization of resources, medical necessity, compliance, payer relationships, and community outreach. The PA promotes efficient documentation to support patient Level of Care (LOC), billing status, and appropriate Medicare Severity‑Diagnosis Related Group (MS‑DRG)/DRG assignment. The PA submits monthly time records documenting actual work hours and has no call responsibilities (Monday‑Friday). Reporting Relationship
The PA reports directly to the Chief Medical Officer of St. Michael Hospital – Texarkana. Professional Qualifications
5 years clinical experience Licensed physician in state of residence Board certified in a clinical specialty Certified by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQUARP) – preferred Experienced in utilization review and an understanding of utilization management Served on or chaired a Utilization Management Committee Demonstrated cost‑efficient practice Key Duties and Responsibilities
Utilization Management (20%)
Lead the Utilization Review Committee in collaboration with the Director of Care Management Conduct secondary status reviews for appropriate level of care determination Conduct peer‑to‑peer consults with payer medical directors for denied cases to resolve medical necessity prior to claims submission Monitor key metrics for utilization management and participate in action steps to achieve targets (denial trends, appeals & recoveries, length of stay, condition code 44) Physician & Staff Education (15%)
Provide education on regulatory requirements, billing status, utilization of alternate levels of care, community resources, and end‑of‑life care Work with physicians to facilitate continuity of care referrals Facilitate, Mentor, and Educate (15%)
Mentor/coach utilization case managers to increase knowledge in care progression Educate physicians on the benefits and importance of a clinical documentation program and how to collaborate with CDI specialists Care Management (50%)
Participate in daily Interdisciplinary Rounds (IDRs) and take action to expedite testing and treatment to promote efficient patient care and appropriate LOC Provide guidance to Emergency Department physicians and care management staff to ensure correct LOC designation at intake Act as liaison with payers to facilitate approvals and prevent denials or carved‑out days when appropriate Participate in review of long‑stay patients to determine the most appropriate LOC Review cases that indicate a need for issuance of a hospital notice of non‑coverage determination; discuss with attending physician and, if additional clinical information is unavailable, discuss appeal process with the physician Document patient care reviews, decisions, and other pertinent information per hospital policy Possess foundational knowledge of InterQual and MCG criteria Participate in Care Management Leadership & staff meetings to help identify and progress toward departmental goals Notify the Care Manager of any conflict of interest in reviewing a patient record and assist in identifying a physician to review such record Clinical Documentation Integrity (15%)
Provide feedback to physicians in each service on clinical documentation using specific case examples (3M) Highlights / Benefits
Balanced professional and personal lifestyle Competitive compensation and benefits No state income tax Relocation assistance Community Description
Easy drive to Dallas Enjoy lush green countryside, pine‑tree covered hills, and lakes Year‑round outdoor activities: golfing, hunting, fishing, camping, hiking, and boating Excellent public and private schools Recruiter Contact Information
Liz Flippo Email: liz.flippo@ EEO Statement
EEO is the law - click below for more information: We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at. Seniority level
Mid‑Senior level Employment type
Full‑time Job function
Health Care Provider Industries
Hospitals and Health Care
#J-18808-Ljbffr
The Physician Advisor (PA) is a full‑time administrative physician serving CHRISTUS St. Michael Hospital and its affiliates. The PA teaches, consults, and advises the Care Management Department and the medical staff on physician practice patterns, documentation, utilization of resources, medical necessity, compliance, payer relationships, and community outreach. The PA promotes efficient documentation to support patient Level of Care (LOC), billing status, and appropriate Medicare Severity‑Diagnosis Related Group (MS‑DRG)/DRG assignment. The PA submits monthly time records documenting actual work hours and has no call responsibilities (Monday‑Friday). Reporting Relationship
The PA reports directly to the Chief Medical Officer of St. Michael Hospital – Texarkana. Professional Qualifications
5 years clinical experience Licensed physician in state of residence Board certified in a clinical specialty Certified by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQUARP) – preferred Experienced in utilization review and an understanding of utilization management Served on or chaired a Utilization Management Committee Demonstrated cost‑efficient practice Key Duties and Responsibilities
Utilization Management (20%)
Lead the Utilization Review Committee in collaboration with the Director of Care Management Conduct secondary status reviews for appropriate level of care determination Conduct peer‑to‑peer consults with payer medical directors for denied cases to resolve medical necessity prior to claims submission Monitor key metrics for utilization management and participate in action steps to achieve targets (denial trends, appeals & recoveries, length of stay, condition code 44) Physician & Staff Education (15%)
Provide education on regulatory requirements, billing status, utilization of alternate levels of care, community resources, and end‑of‑life care Work with physicians to facilitate continuity of care referrals Facilitate, Mentor, and Educate (15%)
Mentor/coach utilization case managers to increase knowledge in care progression Educate physicians on the benefits and importance of a clinical documentation program and how to collaborate with CDI specialists Care Management (50%)
Participate in daily Interdisciplinary Rounds (IDRs) and take action to expedite testing and treatment to promote efficient patient care and appropriate LOC Provide guidance to Emergency Department physicians and care management staff to ensure correct LOC designation at intake Act as liaison with payers to facilitate approvals and prevent denials or carved‑out days when appropriate Participate in review of long‑stay patients to determine the most appropriate LOC Review cases that indicate a need for issuance of a hospital notice of non‑coverage determination; discuss with attending physician and, if additional clinical information is unavailable, discuss appeal process with the physician Document patient care reviews, decisions, and other pertinent information per hospital policy Possess foundational knowledge of InterQual and MCG criteria Participate in Care Management Leadership & staff meetings to help identify and progress toward departmental goals Notify the Care Manager of any conflict of interest in reviewing a patient record and assist in identifying a physician to review such record Clinical Documentation Integrity (15%)
Provide feedback to physicians in each service on clinical documentation using specific case examples (3M) Highlights / Benefits
Balanced professional and personal lifestyle Competitive compensation and benefits No state income tax Relocation assistance Community Description
Easy drive to Dallas Enjoy lush green countryside, pine‑tree covered hills, and lakes Year‑round outdoor activities: golfing, hunting, fishing, camping, hiking, and boating Excellent public and private schools Recruiter Contact Information
Liz Flippo Email: liz.flippo@ EEO Statement
EEO is the law - click below for more information: We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at. Seniority level
Mid‑Senior level Employment type
Full‑time Job function
Health Care Provider Industries
Hospitals and Health Care
#J-18808-Ljbffr