Physician

• Conduct physician-to-physician reviews for medical necessity, level of care, and denial prevention/appeals
• Support utilization review and case management teams with complex clinical decision-making
• Communicate with the Physician Advisory team, hospital physicians, care coordination, and utilization management staff to promote evidence-based care and documentation
• Assist in improving documentation related to ICD coding, severity of illness, risk of mortality, and DRG assignment
• Keep current with CMS and MCG evidence-based guidelines
• Maintain compliance with legal, regulatory, accreditation, and payer partner requirements
• Meet productivity and quality standards within established time requirements
• Attend required training and meetings
• Participate in peer review as needed
• Protect and disclose patients’ PHI in accordance with HIPAA standards
• Limit PHI access to the minimum necessary for assigned duties
• Perform other duties as assigned

Explore Physician Advisor at Med-Metrix. Review requirements and application details.

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