|The Physician Advisor Clinical Documentation & Integrity Specialist is a physician serving the hospital through teaching, consulting, and advising both the case management/utilization review department and the hospital on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer rules and regulations, and working in collaboration with payers and the community. The Physician Advisor is a key member of the organization’s leadership team charged with meeting goals of cost and quality of care.
The Physician Advisor acts as a liaison to the Medical Staff for Case Management/Utilization Review operations and conducts clinical reviews on cases referred by Case Management (CM) staff and/or other healthcare professionals, in accordance with the hospital’s established Utilization Management (UM) Plan. The Physician Advisor meets the hospital objectives for assuring quality patient care and effective, efficient utilization of health care services.
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