Physician Hospitalist - Competitive Salary Job at CommonSpirit Health, Houston, TX

ZUtjRzE3c0RLRjF1Ry9xdmxEc05zRjZ6SXc9PQ==
  • CommonSpirit Health
  • Houston, TX

Job Description

Job Description

Responsibilities

This is a remote position and you must be licensed in the state of Texas. 

As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred by case management staff and/or other health care professionals to meet regulatory requirements and, in accordance with the hospital’s objectives for providing quality patient care, to assure effective and efficient utilization of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level of care, as well as, communicates remotely with medical staff members and medical directors of third-party payers to discuss the needs of patients and options/alternatives for care. The PA acts as a consultant to, and resource for, attending physicians regarding their decisions relative to appropriateness of hospitalization, appropriate level of care for initial hospitalization and continued stay days, clinical documentation, and use of healthcare resources. The PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations. The PA must demonstrate interpersonal and communication skills and must be clear, concise and consistent in the message to all constituents.

Key Responsibilities
  • Conducts medical record review in appropriate cases for medical necessity of hospital admission, continued hospital stays, adequacy of discharge planning and quality care management.
  • Understand the intricacies of the Medicare Inpatient Prospective Payment System (IPPS) to make medical determinations on severity of illness, acuity, risk of mortality, and communicate with treating physicians in cooperation with the utilization team and health information staff.
  • Understand the intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG.
  • Contacts Case and Utilization Management Teams: Makes telephonic/electronic contacts with case and utilization management to discuss clinical aspects of hospital encounters, as well as, medical necessity and appropriate levels of care.
  • Contacts Attending Physicians: Makes telephonic/electronic contacts with Attending Physicians to discuss clinical aspects of hospital encounters, as well as, medical necessity and appropriate levels of care. Discussion may also include education for improved clinical documentation, in addition to, governmental and commercial guidelines for reimbursement.
  • Conducts Peer to Peer discussions with payers as needed.
Qualifications
  • MD or DO required
  • Unrestricted license in field of practice in the state of Texas required.
  • Minimum of 1 year of experience as a Physician Advisor preferred.
  • Minimum of 5 years of clinical practice required.
  • Experience performing Peer to Peer Reviews, preferred
  • Broad-based knowledge regarding clinical practice. 
  • Broad knowledge base with trust and respect of medical staff physicians.
  • In-depth knowledge of CMS regulations, including understanding of the 2-midnight rule.
  • Utilization management experience.
  • Education in quality and utilization management through continuing medical education programs and self-study.
  • Knowledge of and practical use of good business English, spelling, arithmetic, practices and the ability to communicate effectively using written and verbal skills.

 

#LI-CSH

#LI-Remote

Overview

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Pay Range
$79.24 - $114.89 /hour

Job Tags

Work from home, Night shift,

Similar Jobs

Beacon Mobility - Rolling V Bus

Part-time School Bus Driver Job at Beacon Mobility - Rolling V Bus

 ...Rolling V Bus Corp. A Driver is responsible for transporting clients from their pickup point to their destination in a timely and safe manner. Using a vehicle to successfully transport people, performing pre-trip inspections, performing child checks post-route, and... 

Oregon Health & Science University

Care Coordinator 2 Job at Oregon Health & Science University

 ...such as laboratory and imaging, specialty care, primary care, social work and communicate the plan to the patient and patient's representative...  ...8:00am-4:30pm. Possibility of hybrid work 3 days working from home, 2 days working in clinic. Physical demands include pushing,... 

Direct Staffing Inc

INPATIENT CODER Work from home Job at Direct Staffing Inc

We are looking for a remote inpatient coder -- this position can work for home full time!Requirements:Successful completion of an accredited coding programCCS, RHIT, or RHIAA minimum of 3 years inpatient coding in an acute care settingWhen sending candidates -- they... 

DataAnnotation

Bilingual AI Content Writer (EN/ZH) Remote, Flexible Hours Job at DataAnnotation

 ...A leading technology firm is seeking an AI Content Writer (Chinese/English) for a remote position. The role involves training AI chatbots by evaluating their outputs and creating novel conversations. Ideal candidates should be fluent in both Chinese and English, detail... 

Taurus Industrial Group, LLC

Sheet Metal Worker Job at Taurus Industrial Group, LLC

 ...We are seeking a skilled Metal Worker to join our dynamic team in Beaumnt TX. The ideal candidate will possess a strong background in metal fabrication and machining, with a focus on precision and quality. As a Metal Worker, you will be responsible for creating and assembling...