Physician Advisor Responsibilities
The Physician Advisor (PA) has responsibility for providing medical staff leadership to the Utilization Management Committee (UMC) and functions of the Case Management (CM) and Health Information Management (HIM)/Clinical Documentation Improvement Departments. The PA leads and promotes processes for patients to receive medically necessary and high quality care throughout the continuum of care. In addition, the PA promotes medical care that reflects professional best practices and community standards of care. The PA also assists in reducing the financial risks associated with denials that are due to providing medically unnecessary or preventable services and extended length of stays.
Additionally, the Physician Advisor provides ongoing education and in-service instruction programs for the Hospital’s medical staff (including residents and fellows in academic medical centers), nursing and ancillary personnel related to coding/clinical documentation improvement, compliance, utilization management and quality issues. Further, the PA conducts and documents reviews and for cost and length of stay (LOS) outliers as referred by the non-physician reviewers. He/she conducts medical necessity reviews for cases not referred to an outsourced physician advisor company.
A Doctor of Medicine degree (M.D.) or Doctor of Osteopathic Medicine degree (D.O.) is required. A current Medical License for the state where practicing as a Physician Advisor. An advanced degree in Business and/or Health Care Administration is desirable.
Candidates for this position are required to have an ABMS (American Board of Medical Specialties) certification. .
Required Background Experience
Active hospital medical staff member in good standing with current hospital is required.
Utilization Management and hospital committee chair experience highly preferred.
Demonstrated ability to work in a collegial role with members of the medical staff and to engage in education to hospital medical staff preferred.
Solid background in successfully conducting physician-to-physician discussions with payers strongly preferred.
Minimum two years of experience in a physician leadership role is required.
A demonstrated track record of superior performance in physician leadership roles; a background should have been gained ideally in an health system or major medical group that is recognized for excellence in clinical care and contemporary medical management practices.
The successful candidate will be recognized for knowledge in clinical process improvement.
Business skills in planning, use of information systems, financial management, budgeting, reimbursement and managed care, healthcare economics, medical practice management, human resources management and team building, program development, community education, and marketing/referral base development.
Clinical leadership skills in quality and utilization management, clinical effectiveness and outcomes, clinical staff development, case management, clinical protocol development.
Demonstrated knowledge of managed care and health policy that encourages visionary thinking.
A flexible management style, with the ability to function in an environment where it will be necessary to produce proactive results and to lead major change initiatives in an aggressive time.
Significant understanding of and experience with performance improvement and quality management programs.
In depth understanding of financial systems and reimbursement mechanisms.