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Physician Advisor II
<p style="margin: 0; font-size: 14px; line-height: 1.6; color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; white-space: normal; background-color: rgba(255, 255, 255, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><strong style="font-weight: bolder;">Job Purpose</strong></span></p> <p style="margin: 0; font-size: 14px; line-height: 1.6; color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; white-space: normal; background-color: rgba(255, 255, 255, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">The Physician Advisor II serves as a leader on the Physician Advisor team, mentoring, teaching internally and externally, maintaining quality across the spectrum of Physician Advisors, and manages PAOC relationships with clients. Additionally, the Physician Advisor II performs case reviews of all case types in a knowledgeable and conscientious manner to achieve the highest degree of compliance. The Physician Advisor II works closely with the Client’s medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to recommend methods to optimize use of hospital services for all patients while also ensuring the quality of care. This includes identifying opportunities to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.</span></p> <p style="margin: 0; font-size: 14px; line-height: 1.6; color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; white-space: normal; background-color: rgba(255, 255, 255, 1);"> </p> <p style="margin: 0; font-size: 14px; line-height: 1.6; color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; white-space: normal; background-color: rgba(255, 255, 255, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><strong style="font-weight: bolder;">Duties and Responsibilities</strong></span></p> <ul style="color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; font-size: 14px; white-space: normal; background-color: rgba(255, 255, 255, 1);"> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Case Management department in a timely fashion</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Provides consultation to attendings, nurses, and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Maintains accountability for achieving case management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Describes ways to provide improved health record documentation that specifically affect ICD code assignment capture of severity, acuity, risk of mortality, and DRG assignment</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Meets production standards within established time requirements. Work product and performance meets quality standards</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Achieve performance goals as outlined in employment agreement</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Maintains confidentiality of patient care and business matters</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Demonstrates behavior that supports the organization’s mission. Participates in required orientation and training related to the Physician Advisor role</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Demonstrates commitment to meeting/exceeding strategic initiatives of organization</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Upholds the organization’s values of team work and professionalism and applies Code of Conduct standards to all members of the healthcare team</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Facilitate, mentor, and educate other physicians regarding payer requirements</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Attends all meetings as requested by PAOC leadership</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Participate in the peer review process as may be necessary or requested</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Maintain medical licensure and board certification in good standing</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Manages client relationships for PAOC, directing quarterly report creation and JOCs (in concert with the Director of Operations), achieving customer satisfaction and retention</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Contributes to execution of PAOC’s Quality program and continuous PA development</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Provides education to client facilities’ staff on a variety of relevant topics</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Mentors and trains new Physician Advisors as well as existing Physician Advisors to ensure the highest possible consistency and quality for PAOC determinations</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Serves as Team Lead for Physician Advisors for Dashboard management as scheduled</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Fulfills additional duties as needed within the Physician Advisor II role</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; background-color: rgba(255, 255, 255, 1); line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text;">Other duties as assigned</span></span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; background-color: rgba(255, 255, 255, 1); line-height: 16px;"> </span></span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Understand and comply with Information Security and HIPAA policies and procedures at all times</span></li> <li style="margin: 0; font-size: 10pt; font-family: Montserrat; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties</span></li> </ul> <p style="margin: 0; font-size: 14px; line-height: 1.6; color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; white-space: normal; background-color: rgba(255, 255, 255, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><strong style="font-weight: bolder;">Qualifications</strong></span></p> <ul> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Specialty Board Certified</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Licensed to practice medicine in the US</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">3+ years working as a Physician Advisor or UR/UM Medical Director performing case reviews</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Basic technical skills with Hospital EMRs and Microsoft Office and Teams a must</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Hold and maintain an unrestricted medical license and Board Certification</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Possess or acquires a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Possess a working knowledge of (Hospital) organization & case management operations and administrative standards and policies</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Familiarity with MCG/InterQual placement status criteria is preferred</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Member of the American College of Physician Advisors (ACPA) preferred</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Physician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text;">Proficiency</span><span style="margin: 0; padding: 0; user-select: text;"> in Microsoft Office Suite</span></span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"> </span></span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text;">Strong interpersonal skills, ability to communicate well at all levels of the organization</span></span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"> </span></span></span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text;">Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on </span><span style="margin: 0; padding: 0; user-select: text;">accurate</span><span style="margin: 0; padding: 0; user-select: text;"> and </span><span style="margin: 0; padding: 0; user-select: text;">timely</span><span style="margin: 0; padding: 0; user-select: text;"> analyses</span></span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"> </span></span></span></span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; background-color: rgba(255, 255, 255, 1);">High level</span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; background-color: rgba(255, 255, 255, 1);"> of integrity and dependability with </span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; background-color: rgba(255, 255, 255, 1);">a strong sense</span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; background-color: rgba(255, 255, 255, 1);"> of urgency and results oriented</span></span></span></span></span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; background-color: rgba(255, 255, 255, 1);"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text;">Excellent written and verbal communication skills </span><span style="margin: 0; padding: 0; user-select: text;">required</span></span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"> </span></span></span></span></span></span></li> </ul> <p style="margin: 0; font-size: 14px; line-height: 1.6; color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; white-space: normal; background-color: rgba(255, 255, 255, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><strong style="font-weight: bolder;">Working Conditions</strong></span></p> <ul style="color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; font-size: 14px; white-space: normal; background-color: rgba(255, 255, 255, 1);"> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);">Monday to Friday for assigned shifts ranging from 8 a.m.-5 p.m. EST to 9 a.m.-6 p.m. EST as assigned by PAOC on a rotating basis; with a holiday coverage requirement of up to 3 holidays per year</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"><span style="margin: 0; padding: 0; user-select: text;">Must</span><span style="margin: 0; padding: 0; user-select: text;"> </span><span style="margin: 0; padding: 0; user-select: text;">possess</span><span style="margin: 0; padding: 0; user-select: text;"> a </span><span style="margin: 0; padding: 0; user-select: text; background-position: left bottom; background-repeat: repeat-x; border-bottom: 1px solid rgba(0, 0, 0, 0);">smart-phone</span><span style="margin: 0; padding: 0; user-select: text;"> or electronic device capable of downloading applications, for multifactor authentication and security purposes.</span></span><span style="margin: 0; padding: 0; user-select: text; text-align: left; white-space: pre-wrap; line-height: 16px;"> </span></span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><em>Physical Demands: </em>While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><em>Mental Demands: </em>The employee must be able to follow directions, collaborate with others, and handle stress.</span></li> <li style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><em>Work Environment:</em> The noise level in the work environment is usually minimal.</span></li> </ul> <p style="margin: 0; font-size: 14px; line-height: 1.6; color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; white-space: normal; background-color: rgba(255, 255, 255, 1);"> </p> <p style="margin: 0; font-size: 14px; line-height: 1.6; color: rgba(34, 34, 34, 1); font-family: 'Open Sans', Helvetica, Arial, sans-serif; white-space: normal; background-color: rgba(255, 255, 255, 1);"><span style="font-family: Montserrat; font-size: 10pt; color: rgba(0, 0, 0, 1);"><em>Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.</em></span></p>