Physician Advisor

Position Summary 
Responsible for medical staff leadership to the Utilization Management Committee (UMC) and the Case Management (CM) and Health Information Management (HIM)/Clinical Documentation Improvement Departments. Leads and promotes processes for patients to receive medically necessary and high quality care throughout the continuum of care. Stays abreast of professional best practices and community standards of care. Assists Administration in reducing financial risks associated with denials that are due to providing medically unnecessary or preventable services and extended length of stays.

• Provide and document ongoing education and in-service instruction programs for Hospital’s nursing and ancillary personnel related to the Program and focus on coding, compliance, utilization management and quality issues.

• Conduct and document reviews to determine medical necessity and level of care issues when patients do not meet Interqual criteria and for cost and LOS outliers as referred by the non-physician reviewers.

• Provide consultation for the Risk Manager and liaison with physicians in matters of reportable events, eg Code 15s and disclosure of unanticipated outcomes in compliance with JCAHO standards and the patient safety policy and in relation to conflicts about end of life issues.

• Make recommendations to Hospital’s administration regarding the use of Hospital personnel, any necessary equipment, and general quality standards of patient care.

• Develop and document ongoing medical education and in-service instruction programs for Hospital’s medical staff relating to issues identified by the Program and focus on coding, compliance, utilization management, quality and patient safety issues and recommend changes to Hospital’s policies and procedures.

• Attend and be a liaison to appropriate Medical Staff Committees relevant to the Program   to provide input and guidance to ensure appropriate actions are taken when necessary to mediate conflicts when they arise (for example:  Medical Executive Committee, PIM Committee and Patient Safety Committee and Medical Staff Peer Review Committees.).

• Minimum Requirements 

  • Education: Doctor of Medicine Degree (M.D.) or Doctor of Osteopathic Medicine Degree (D.O.).
  • Experience:  
    • 2 years in a physician leadership role.
    • Prefer Utilization Management and hospital committee chair.
    • Prefer demonstrated ability to work in a collegial role with members of the medical staff and to engage in education to hospital medical staff.
  • Licensure/Certifications: Current State MD or DO License and an ABMS (American Board of Medical Specialties) Certification.

• Preferred Requirements 

  • Education:  Advanced degree in Business and/or Health Care Administration

#LI-