Educational Resources for a Physician Advisor for Utilization Reviews and CDI

One of the best nonclinical jobs for physicians is doing Utilization Reviews either for the hospital you work for or for an insurance company. Most physicians start these jobs after a few years after becoming an attending.

The salary is typically $200K-$300K. It totally depends on where you work.

The work is more predictable and not as stressful compared to clinical work. You can-do part-time UM and part time clinical work so you get best of both the worlds.

If you are really interested, you can start making plans as soon as you become attending as these jobs take some time to find.

If you want to join your hospital’s Utilization Management team, you should tell your medical director about your plan. When an opportunity arises in your hospital, your medical director will strongly consider you for that role.

Meanwhile, you can get yourself prepared to become a physician advisor by doing a few things. Join hospital committees like Quality Improvement committee, Utilization Management committee, Clinical Documentation Integrity/Improvement committee etc. Most insurance companies give “On the job” training once you join them.

Learn more about MCG and InterQual guidelines.

Participate in administrative roles in your hospital.

Some insurance companies want you to be clinically active at least a few days a month if you are doing full time UM work for them. You also need to be Board Certified in your specialty to be able to continue to do UM work.

Here are some helpful sources for improving skills as a physician advisor.

Utilization Management/Review:

Step by Step Guide on How to Become an ‘Independent Physician Reviewer’-Here is a guest post detailing as to how one can become an independent reviewer to do Utilization reviews.

Physician Advisor and Utilization Review Boot Camp-We were told to attend to these lectures when we started working as a physician advisor. I only see 2019 lectures. Not sure if they are doing any yearly.

Learn Key points about Peer-to-Peer appeals-Here are some practical tips as to how to do peer to peer reviews.

MCG Care Guidelines Specialist Certification-This is not a must but just one more tool that is useful for doing status determination while working as a physician advisor.

American College Of Physician Advisors courses-They give CME that you can use to augment your CV when applying for UM jobs.

Become a certified Physician Advisor. You do not need a certification but helps to prove your commitment if you have certification.

Apply for Utilization Review or Chart Review Jobs for Physicians-Here you can apply for jobs and if they have vacancy, they can reach out to you.

ACPA [American College of Physician Advisors] jobs board page to look for jobs available-This page has vacant jobs that are currently available.

Utilization Management and Clinical Documentation for Hospitalists from SHM. Utilization Management and Clinical Documentation for Hospitalists is an interactive educational series with two modules. Short session lengths allow for participants to navigate the course at their own pace, while knowledge checks and a post-module quiz reinforce learning and increase retention between sessions. Module 1: The Basics-What every hospitalist should know about utilization management and clinical documentation.

  • Part I: Utilization Management Basics
  • Part II: Medical Necessity and Clinical Documentation Basics

Module 2: Case Study Discussions-Applying fundamental concepts to common diagnoses in hospital medicine.

  • Session 1: Pulmonary & Infectious Disease
  • Session 2: Gastrointestinal & Renal
  • Session 3: Cardiology
  • Session 4: Neurology
  • Session 5: COVID
  • Session 6: Post-op Hip Fracture.

Search the websites of companies that do UM work like health insurers in your community. Search jobs for “medical directors” on LinkedIn or Indeed or just google it.

A few tweaks in your current CV or resume can help your resume stand out. Design your CV or resume to include the keywords that the companies list in their job description if you have similar prior relevant experience. Your application will be reviewed first by the HR people in the company. You have to get past them before your resume is seen by anyone else at the company.

Update your profile on LinkedIn.

Some people separate clinical work from admin work in their resume to make it easy for companies that are hiring. Some hire a resume consultant.

Show your CV to at least one or two people in the relevant field and ask for suggestions. You never know how useful this can be. Having a great mentor in any field makes your success easy.

Corporations sometimes post jobs and then some internal change occurs, and they decide not to hire, and applicants are not told about this. So don’t be discouraged if you have to try multiple times.

Clinical Documentation Integrity:

CDI Physician Advisor Tips from Brundage group-Lot of tips to help document better.

Certified Clinical Documentation Specialist (CCDS)-This certification helps to advance your career in CDI field as a physician advisor. It is not a must.

Certified Documentation Improvement Practitioner (CDIP)-This is another certification that some physicians who are in CDI get.

Also, join our Facebook group if you have not joined already.

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1 thought on “Educational Resources for a Physician Advisor for Utilization Reviews and CDI”

  1. Could we arrange a time to chat tomorrow? Am a PA and would like to discuss your materials. Materials look very helpful. Thank you.

    Reply

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