CDI Physician Advisor

Physician Advisor

We are so glad you are interested in joining Sutter Health!

Organization: SHSO-Sutter Health System Office-Bay

Position Overview: The Physician Advisor (PA) is a key member of the hospital's leadership team charged with meeting the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity, documentation best practices, level of care progression, denial management and compliance with governmental regulations and conditions of participation and commercial insurance contracts. The PA is responsible for establishing, maintaining and strengthening the relationship with System Enterprise and the hospital to appropriately optimize the use of Sutter Health Internal Physician Advisor Services (IPAS). The physician Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to develop and implement methods and strategies to optimize the use of hospital services. This includes care management processes that ensure patients are in the appropriate level of care with supporting documentation of regulatory compliance and accurate coding. The Physician Advisor (PA) conducts clinical reviews on cases referred by UM/CM staff and or other healthcare professionals to meet regulatory requirements in accordance with the hospital objectives for assuring quality patient care and effective, efficient utilization of health care services. The PA meets with care management, UM staff and health care team members and medical directors of third-party payers to discuss the needs of patient's and alternative levels of care. The PA acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources. The PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations. The PA will act as a liaison between the CDI (Clinical Documentation Improvement) professional, HIM (Health Information Management), and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk for mortality, in addition to Direct Report Groups (DRG) assignment. This is a hybrid role with some onsite requirements in the dedicated area.

Job Description:

Education:

• Doctorate: Graduate of an accredited medical school

Certification & Licensure:

• MD-Doctor of Medicine OR DO-Doctor of Osteopathy
• Unrestricted medical license in state of residence

Typical Experience:

• 3 years of recent relevant experience.

Skills and Knowledge:

Quality Management & Performance Improvement: Effectively leads change in behavior on the documentation needs of the medical staff and other clinical providers to achieve organizational objectives related to quality improvement and revenue cycle initiatives. Assists with the creation and implementation of documentation strategies for accurate and complete reflection of the quality of care. Applies knowledge of coding rules and regulations, along with understanding of risk adjustment and quality reporting methodology to achieve organizational goals. Elicits optimal value from documentation as a marker of quality of care

Operations: Reviews cases escalated by CDI team for potential documentation opportunities. Participates in unanswered query escalation process by following up with physicians electronically and in-person to obtain query responses. Meets regularly with CDI Director, CDI Managers, and CDI Leads to understand current areas of opportunity and discuss unanswered queries. Provides clinical feedback and provider perspective to CDI team to build credibility of the program and CDI staff. Partners in the development, coordination and presentation of provider education:

• Focused on improving the accuracy of documentation and the reflection of the quality of patient care reported, expected mortality, expected length of stay, medical necessity and other documentation related outcomes.
• Shares key clinical documentation concepts and their importance for hospital and individual providers
• Tailors education content and messaging to specific provider groups and specialties

Collaborates with subspecialty providers to create consistent definitions and documentation around complex conditions. Develops and participates in recognition process for providers that have made significant positive impacts to the program. Helps to develop clinically appropriate and compliant provider queries to clarify documentation. Evaluates current documentation systems, tools and processes and recommends innovative initiatives and improvements. Provides guidance and coaching to providers on how to use updated functionality effectively. Leads multidisciplinary and multi-departmental provider engagement strategies related to CDI strategic goals and objectives. Involved in Clinical Documentation Integrity Steering Committee and Quality Committees, as appropriate.

Communication: Serves as liaison for providers and CDI team to address issues and questions. Proactively manages each group's perspectives and facilitates a collaborative relationship among stakeholders. Holds one-on-one meetings with physicians to address areas of opportunity and respond to questions. Identifies preferred methods of communication for individual providers and/or provider groups.

Quality, Financial and Data Management: Regularly reviews key process and outcomes metrics related to the CDI program:

• Process metrics: provider response rates, agree rates, response times, query trends, among others
• Outcomes metrics: medical and surgical capture rates, capture rates by service line, capture rates by DRG triplets and pairs, case mix index, expected mortality, observed to expected mortality ratio, CMS Star ranking, Vizient rankings and risk variable capture, Leapfrog rating, among others

Develops action plans for non-responsive providers, providers with high disagreement, and service lines with risk variable capture opportunity. Reports performance data and significant issues to senior leadership.

Job Shift: Days

Schedule: Part Time

Days of the Week: Monday - Friday

Weekend Requirements: As Needed

Benefits: Yes

Unions: No

Position Status: Exempt

Weekly Hours: 20

Employee Status: Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.