What are the responsibilities and job description for the Physician Advisor position at Physician Pivot?
Physician Advisor – Part Time
The Physician Advisor serves as a critical bridge between clinical practice and operational excellence, supporting Centra Health’s goals in delivering high-quality, cost-effective, and patient-centered care. This role provides physician leadership across utilization management (UM), clinical documentation integrity (CDI), care progression, regulatory compliance, and performance improvement.
Working collaboratively with clinical teams, operational leaders, and support departments, the Physician Advisor promotes clinical efficiency, drives compliance with CMS guidelines, and enhances overall care coordination.
Education & Certification
The Physician Advisor serves as a critical bridge between clinical practice and operational excellence, supporting Centra Health’s goals in delivering high-quality, cost-effective, and patient-centered care. This role provides physician leadership across utilization management (UM), clinical documentation integrity (CDI), care progression, regulatory compliance, and performance improvement.
Working collaboratively with clinical teams, operational leaders, and support departments, the Physician Advisor promotes clinical efficiency, drives compliance with CMS guidelines, and enhances overall care coordination.
Education & Certification
- MD or DO with active board certification in a clinical specialty.
- Current license to practice medicine in Virginia.
- Minimum 3–5 years of clinical practice experience.
- Support the Physician Advisor Director with building the comprehensive program with scheduling and coverage support, leadership development, and programmatic budgeting
- Act as a trusted clinical advisor, fostering alignment between physicians and operational priorities.
- Partner with Physician Advisor Director leading clinical teams in performance improvement initiatives related to LOS, documentation, throughput, and cost of care.
- Support alignment with system-wide strategies in:
- Inpatient Clinical Optimization
- Clinical Documentation Improvement
- Regulatory Readiness
- Cost-of-Care Management
- Review cases to assess medical necessity, appropriate level of care, and length of stay, especially outliers.
- Participate in multidisciplinary rounds to identify and mitigate care progression delays.
- Facilitate peer-to-peer conversations about medical necessity determinations and payer disputes.
- Support throughput efforts by identifying and resolving discharge barriers. Provide input on observation status determinations and ensure appropriate clinical documentation.
- Engage physicians to improve documentation accuracy, specificity, and timeliness.
- Collaborate with CDI and coding teams to address quality metrics influenced by documentation (e.g., PSI-90, SOI/ROM).
- Review query response trends and support escalation or education as needed. Provide education to clinicians on CDI principles, DRG optimization, and coding best practices.
- Ensure compliance with CMS Utilization Management requirements, including Conditions of Participation and relevant policies.
- Support the development and implementation of UM plans, committee structures, and documentation workflows that align with federal and state regulations. Monitor performance and recommend process improvements for compliance and efficiency.
- Translate data into actionable insights for clinical teams, connecting administrative and clinical priorities.
- Champion initiatives promote accountability, clinical consistency, and optimal use of hospital resources.