Anesthesiology Physician

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