Hospital Based Physician Advisor

Hospital based Physician advisors are employed by Hospital systems and perform a wide range of functions.

These roles may be Onsite-hospital based or Part Remote.

Here is a job posting for an Onsite Physician Advisor:

Physician advisor is a broad role, encompassing various areas of healthcare quality and management. 

There are many reasons why Physician advisors are needed

regulatory oversight

policy change 

cost containment 

Medicare audit and denial, 

commercial insurance denial, 

mental state management 

clinical documentation improvement, 

quality outcomes 

patient safety, 

ICD 10 implementation.

The rising healthcare costs necessitate that the business of medicine have a physician voice in it.

The COVID Pandemic has increased the pressure on hospitals to control costs.

Hospital administrators alone are simply not equipped to answer all questions that require input from a clinical perspective. 

The documentation and reimbursement in hospital settings are also complex subjects, physicians have an edge because they are well versed in medicine, familiar with CMS regulation, have to bill and code and work closely with case management.

Add leadership responsibilities as physicians already engage other colleagues, by providing them support and directing with them on a regular basis. It is important these days that the care we provide is effective, efficient, quality and safe.

And who better than a physician to make sure that these are done in an evidence based manner combining clinical expertise and patient advocacy at times.

Here is another example of a job posting for an Onsite Physician Advisor:

Transferable skills for Hospital based Physician Advisors include:

Perform Concurrent admission review 

Participation in daily multidisciplinary rounds

Involvement in patient quality and safety initiatives 

Provide physician education.

Providing support to case management team

Dealing with medical necessity issues

Denial management with case management

Rounding with case management to discuss discharge planning and transition of care to SNF or other facilities

Reviewing medical records

Hospital based documentation improvement initiatives

Patient status designation and dealing with coding related queries

Participation in ICD 10 roll out

UM committee involvement or leadership experience

Involvement in appeal of denials

Participation in coding audit

Discussing medical necessity for patient services

Quality and performance committee involvement

Participation in performance imp activities

Involvement in Med staff

Working closely with nursing and other ancillary staff

Provide clinical perspective at hospital board

Manage patient flow through the several healthcare systems and processes

Participate in Family meetings

Supervise appeal writing

Peer to peer discussions

Educate other professionals about patient status

Educate med staff on coder concerns and study coding patterns

Improve query response rate

Oversee Revenue cycle

Ensure credible documentation

Educate nurses

Guidelines followed in hospital setting 

Interqual 

MCG

Responsibilities of a Physician Advisor:

Provides medical oversight of clinical documentation and participates in clinical documentation improvement initiatives

Provides education to medical staff and bridges the gap between providers and hospital administration

Conducts clinical reviews while working closely with case management

Participates in Discharge planning rounds

Participates in quality initiatives

Ensures safe patient care

Guides level of care decisions

Monitors utilization of diagnostic services

Helps maintain compliance with regulatory oversight

Qualifications needed to be a Physician advisor

A varying mix of following qualifications might be needed

5 years of clinical experience

Board certification in primary specialty

Licensed to practice medicine

Interest in UM

Further education:

A few programs offer extra credentials.

For example ABQUARP offers HCQM certification exam  which can help gain more knowledge and a credential of a board certified Physician Advisor

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