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Physician Advisor II
Med-Metrix. Lead the Physician Advisor team and mentor and teach internal and external stakeholders .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Utilization Management, Case Reviews, and Quality Improvement while effectively leading and mentoring a Physician Advisor team. Proficient in applying MCG/InterQual criteria and maintaining compliance with HIPAA regulations.
Highest-signal resume keywords
Physician Advisor ExperienceUtilization Management KnowledgeMCG/InterQual Criteria ApplicationBoard CertificationStrong Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ReviewUtilization ManagementQuality ImprovementPatient SafetyICD Code CaptureClinical ReviewMedical Necessity AssessmentDashboard ManagementHospital EMR ProficiencyMicrosoft Office Suite
Soft Skills
Interpersonal SkillsProblem-Solving SkillsJudgment and Decision-MakingIntegrity and DependabilityResults Orientation
Tools & Technologies
Hospital EMRsMicrosoft TeamsMultifactor Authentication Applications
Certifications & Qualifications
Board CertificationAmerican College of Physician Advisors MembershipABQAURP CertificationPhysician Advisor Sub-Specialty Certification
Industry Keywords
Physician AdvisorCase Management OperationsHealthcare CompliancePatient CareQuality Program
About the role
Key responsibilities & impact- Lead the Physician Advisor team and mentor and teach internal and external stakeholders
- Maintain quality across the Physician Advisor team and manage PAOC client relationships
- Perform case reviews of all case types to achieve a high degree of compliance
- Respond to clinical review requests regarding medical necessity and other case management matters
- Consult with attending physicians, nurses, and case management staff on complex clinical issues, continued stay, medical necessity, and utilization management
- Apply MCG/InterQual criteria and professional judgment to patient-specific situations
- Support case management outcomes and clinical progression of patient care
- Recommend improvements to health record documentation affecting ICD code capture, severity, acuity, mortality risk, and DRG assignment
- Participate in Physician Advisor, Utilization Management, Care Management, and related training and education
- Meet production, quality, and performance standards
- Maintain patient and business confidentiality and comply with HIPAA and information security policies
- Facilitate, mentor, and educate physicians regarding payer requirements
- Attend meetings and participate in peer review as requested
- Manage PAOC client relationships, quarterly reports, and JOCs
- Contribute to PAOC’s quality program and continuous Physician Advisor development
- Educate client-facility staff on relevant topics
- Mentor and train new and existing Physician Advisors
- Serve as Team Lead for Physician Advisor dashboard management when scheduled
- Perform additional duties as assigned
Requirements
What you’ll need- Specialty Board Certified
- Licensed to practice medicine in the US
- 3+ years working as a Physician Advisor or UR/UM Medical Director performing case reviews
- Basic technical skills with Hospital EMRs and Microsoft Office and Teams
- Hold and maintain an unrestricted medical license and Board Certification
- Possess or acquire a solid foundation, knowledge, and/or experience in utilization management, quality improvement, and patient safety
- Possess a working knowledge of hospital organization, case management operations, and administrative standards and policies
- Proficiency in Microsoft Office Suite
- Strong interpersonal skills and ability to communicate well at all levels of the organization
- Strong problem-solving and creative skills, with the ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results orientation
- Excellent written and verbal communication skills
- Familiarity with MCG/InterQual placement status criteria is preferred
- Membership in the American College of Physician Advisors (ACPA) is preferred
- Board Certification by ABQAURP is preferred
- Physician Advisor Sub-Specialty Certification by ABQAURP is preferred
- Must possess a smartphone or electronic device capable of downloading applications for multifactor authentication and security purposes
Benefits
Comp & perks- Holiday coverage requirement of up to 3 holidays per year
- Multifactor authentication and security device support requirement (smart-phone or electronic device capable of downloading applications)