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Physician - Advisor (Care Management & CDI)
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Full-time
- The PACM also ensures physician support and execution for the Care Management and CDI Departments' initiatives by promoting effective and efficient physician documentation to support the patient's Level of Care (LOC), billing status, and appropriateness of Medicare Severity-Diagnosis Related Group (MS-DRG)/DRG assignment.
- The PACM will submit monthly time records documenting time actually spent in the provision of the responsibilities outlined below.
- Metrics include (but not limited to): •Denial trends, appeals & recoveries •Length of stay- inpatient and observation •Condition Code 44 Physician & Staff Education: 15% •Provide education to physicians and other clinicians related to regulatory requirements, appropriate billing status and utilization of alternate levels of care, community resources, and end of life care.
- Discuss the case with the attending physician and if additional clinical information is not available, discuss the process for issuance and appeal with the physician.
- Document patient care reviews, decisions, and other pertinent information per hospital policy •Possess foundational knowledge of InterQuale 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 particular patient record.
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