Physician Advisor

We are seeking a highly skilled Physician Advisor to collaborate with our healthcare team in providing expert clinical guidance and support. The ideal candidate will have a strong background in medicine and a passion for improving patient care and outcomes.

• Collaborate with care managers and attending physicians to ensure alignment on patient care, billing status, and potential barriers to discharge.
• Conduct clinical reviews of cases to ensure compliance with regulatory requirements, hospital objectives, and quality patient care.
• Guide the team to improve clinical and financial outcomes through documentation and clinical education.
• Educate and support physicians in documenting appropriateness of admission and continued stay, severity, and morbidity/mortality.
• Review patient status when admission criteria is non-sufficient for admission.
• Perform concurrent review and escalation of cases not meeting criteria.
• Provide guidance and advisory services to physicians, case managers, and clinical documentation specialists regarding correct level of care and reimbursement.
• Apply knowledge of utilization review, discharge planning, patient status changes, length of stay, patient monitoring practices, medical necessity concepts, and associated regulations in case management decisions.
• Assist in identifying unnecessary testing, avoidable days, telemetry/ICU overutilization, and antibiotic stewardship.
• Deliver support associated with palliative care, end-of-life care, and hospice.
• Apply knowledge of health insurance and managed care programs, along with values-based care, pay-for-performance programs (all payer types), and reimbursement models in decision making and reviews.
• Provide peer-to-peer payor review in collaboration with attending physicians.
• Assist with mitigating barriers to discharge and care progression.
• Perform concurrent review of cases.
• Partner with the care management team in managing complex care needs and patient throughput efforts.
• Provide transition of care advisement.
• Support education to minimize clinical variability throughout the medical staff.
• Assist case managers with insurance appeals and testimonies.
• Act as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate.
• Perform reviews and appeals (peer-to-peer, retrospective/closed record review, concurrent appeals).
• Act as a liaison between the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data for capture of severity, acuity, and risk of mortality.
• Facilitate, mentor, and educate physicians regarding payer requirements, coding guidelines (e.g., co-morbid conditions, severity, acuity, risk of mortality), and documentation on patient records.
• Actively participate in hospital rounds, committees, etc., and in meetings related to utilization, length of stay, and barriers to discharge.
• Lead discussions involving documentation, decisions on status, and appropriate level of care.
• Help to develop a 'culture of urgency' in managing hospital care, often resulting in reducing resource consumption.
• Interface with the C-Suite in matters regarding metrics and requirements.
• Track and trend outcome Key Performance Indicators (KPIs) for financial and compliance best practice results.
• Provide individual education based on trends and regulatory changes.

The ideal candidate will possess a strong educational background in medicine, specifically a MBBS degree from a medical school recognized by the Singapore Medical Council - SMC.