Physician Advisor

The Physician Advisor (PA) serves as a clinical resource to the medical staff and CMSW by providing identification, facilitation and resolution of utilization issues. The PA role has a matrix reporting structure which includes Corporate Physician Advisor and Corporate CQIO , as well as entity CMO and CEO. The Physician Advisor addresses the following issues: Federal and state compliance, documentation supporting codingmedical necessityclinical validation, appropriate level of care, length of stay, hospital utilization and quality issues. In collaboration with admitting physician, healthcare team, and case management , the PA proactively manages cases at the point of entry and through the hospital stay , to ensure the patient is placed in the proper level of care classification based on medical necessity, severity of illness and risk of mortality . The PA ensures compliance with CMS for appropriate billing . The PA conducts post-discharge reviews related to payer audits. Promotes understanding and cooperation between the medical staff through communication, collaboration and education. Facilitate improvements in clinical practice to achieve better performance, improved cost, reduced length of stay, fewer readmissions, and superior patient care.

Created: 2025-02-22