Physician Advisor

Houston Methodist is seeking a Physician Advisor to join their team, providing essential guidance and consultation to the case management department, clinical documentation specialists, and medical staff. This role focuses on medical necessity, compliance, payer relationships, and resource utilization, ensuring high-quality and cost-effective healthcare. The Physician Advisor will also lead the hospital's utilization review/management committee, contributing to strategic objectives and regulatory goals.Practice InfoKey member and leader of the hospital's utilization review/management committeeWorks within Houston Methodist Clear Lake Hospital, which provides a broad spectrum of adult, pediatric, medical, and surgical careHouston Methodist Clear Lake Hospital is an accredited chest pain center and acute stroke-ready designated through DNVOffers advanced inpatient and outpatient services, including state-of-the-art imaging; childbirth center with a level II neonatal intensive care unit; minimally invasive surgery; cancer center; neurology and spine care; heart and vascular care; bariatric and digestive care; emergency care; primary care; rehabilitation services; and comprehensive orthopedics and sports medicineResponsibilitiesProvide consultation to case management staff regarding complex clinical issues and advise on next stepsChair the utilization review/management committee and actively participate in defining operational strategic objectives for the Utilization Management ProgramAssist with the evaluation of the hospital's Utilization Management Program, including annual review and revision of the hospital's UR planCommunicate to medical staff leaders relevant findings of physician's performance when patterns of clinical outcomes demonstrate undesirable variationRound on patient care units and throughout the hospital to identify opportunities to impact resource utilization and manage length of stayProvide support and assist Clinical Documentation Specialists and Coders on an ongoing basis by addressing specific documentation issuesAct as consultant and resource to attending/responsible physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources in length of stay managementReview medical records to assist with the identification and management of denials and actively participate in the hospital's claim denial processShift & ScheduleWork Shift: 1 - DayMay require travel within the Houston Metropolitan areaRequirementsGraduate of accredited medical schoolFive years experience in clinical practiceMD - Physician - State Licensure - Texas Department of Licensing and Regulation_PSVUnrestricted medical license in the State of TexasDemonstrates understanding and knowledge of utilization management, clinical documentation, and state and federal healthcare regulationsActive practitioner