Physician Advisor - Silver Spring, MD

Our organization is looking for a full-time Physician Advisor to join our team in Silver Spring, Maryland.

The Physician Advisor will offer specialized knowledge regarding appropriate utilization and level of care (LOC), management of length of stay (LOS), patient flow, clinical documentation, and Clinical Documentation Improvement (CDI). This role involves engaging with physicians to enhance care coordination, ensure consistent care progression, and support CDI initiatives. The Physician Advisor will also review and provide insights on policies related to care coordination, patient access, and CDI. Collaboration with relevant departments, leadership, and committees is essential to achieve set goals for physician engagement and adherence to expectations. Additionally, the role includes designing, implementing, and overseeing system-wide programs for Infection Control, aligning with the mission of our organization.

What We Provide:

• Benefits, complimentary parking, and employee discounts.
• Quality of Life: Flexible work schedules to promote a healthy work-life balance.
• Advancement: Opportunities for professional development within the organization.
• Location: Our organization operates two hospitals and four healthcare centers, all conveniently located near Washington, DC, and Baltimore, MD.

KEY RESPONSIBILITIES

• Inpatient/Observation Clinical Optimization: Act as a physician expert, providing support to care teams and coordination staff regarding utilization decisions, including assessing hospitalization appropriateness, LOC status, LOS management, continued stay decisions, clinical reviews, utilization review activities, resource management, denial management, discharge planning advice, and quality issues. Serve as a consultant and resource for other Physician Advisors and attending physicians.
• Collaboration: Assist care teams to ensure proper patient placement and discharge processes. Ensure that medical staff understand and comply with relevant areas of expertise.
• Clinical Documentation Improvement: Offer educational input and guidance to medical and CDI staff.
• Regulatory and Accreditation: Stay informed about regulatory and accreditation standards related to utilization review, LOC, and clinical documentation.
• Revenue Excellence: Conduct verbal and written peer-to-peer reviews to support appeals for denied or downgraded coverage determinations from managed care, commercial payers, and recovery audit contractors.

MINIMUM QUALIFICATIONS

• Graduation from an accredited medical school.
• Completion of a specialty residency (e.g., Internal Medicine, Emergency Medicine).

Experience:

• Preferred: Five years of recent clinical practice experience in a hospital setting.
• Preferred: Previous experience as a physician advisor.
• Preferred: Involvement in medical staff committees.
• Current active medical staff privileges are required.

Licensure, Registration, or Certification Required:

• Board Certified/Eligible Physician licensed in Maryland and applicable states.

Knowledge, Skills, and Abilities:

• Strong clinical judgment.
• Understanding of Care Management principles and their practical application.
• Familiarity with third-party payer guidelines and medical necessity criteria.
• Knowledge of denial management strategies.
• Awareness of clinical, quality, and administrative aspects of healthcare.
• Understanding of clinical documentation requirements.
• Knowledge of Centers for Medicare and Medicaid Services regulations, with a desire to expand this knowledge through experience and collaboration with Care Management.
• Excellent communication and presentation skills, both written and verbal.
• Teaching and coaching abilities.
• Analytical and problem-solving skills.
• Proficiency with electronic medical records.
• Familiarity with process improvement methodologies.
• Ability to work effectively within the medical staff structure and in inter-professional teams.
• Capability to function effectively in potentially disruptive environments or in the face of peer resistance.
• Willingness to engage in ongoing education as recommended by local management leaders.

Compensation: $98.65 - $147.98 per hour.

Compensation is determined by experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will receive pay within the stated hourly range. The pay may vary based on location.

Our organization is an Equal Employment Opportunity (EEO) employer. We consider qualified applicants for employment without regard to race, gender, disability, or veteran status.