Overview
GENERAL SUMMARY OF POSITION:
Under the general direction of the Medical Director, Director, or designee, the Physician Advisor is responsible for reviewing applicant medical records and making a clinical determination of eligibility for applicants seeking benefits and/or long term care services based on clinical guidelines. The Physician Advisor also provides clinical guidance reviewers and quality improvement initiatives as appropriate.
Responsibilities
MAJOR RESPONSIBILITIES:
- Responsible for determining whether an individual applying for and/or receiving public assistance benefits/services meets specific clinical and functional criteria outlined in federal and state regulations
- Review medical records, approves or denies recommendations made by Registered Nurse Reviewers regarding the status of an applicant or member
- Participates in and advises review team regarding the functional capability of an applicant based upon a comprehensive review of all records
- Contributes to quality improvement initiatives developed within the program or department
- Participates in quality team case reviews
- Collaborate with department leadership in the interpretation of all applicable regulations, development of clinical policies and quality evaluations, and provide feedback to clinical staff regarding clinical policies and the outcomes of quality evaluations
- Evaluates and develops alternatives to address problems and issues as they arise on a case by case basis
- Participates as a member of clinical or case review teams
- Responsible for training new Physician Advisors
- Performs other duties as assigned.
Qualifications
REQUIRED QUALIFICATIONS:
- Board eligible or certified in area of specialty
- Minimum of 5 years of experience in direct patient care
- Proven ability to plan and prioritize work in order to meet position objectives or job responsibilities
- Excellent problem solving and decision making capabilities
