Physician Advisor

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 clinical leadership and guidance to the Utilization Management Committee (UMC), Case Management (CM), and Health Information Management (HIM)/Clinical Documentation Improvement (CDI) teams to support effective patient care and resource utilization.
• Promote medically necessary and high-quality care by leading initiatives that ensure appropriate patient treatment and services throughout the continuum of care.
• Collaborate with physicians and interdisciplinary teams to improve utilization management practices, patient outcomes, and compliance with regulatory and payer requirements.
• Maintain expertise in healthcare best practices and standards of care by staying current with industry guidelines, evidence-based medicine, and community care standards, and sharing this knowledge with medical staff.
• Support denial prevention and financial stewardship efforts by assisting administration in reducing financial risks related to medical necessity denials, preventable services, and unnecessary extended lengths of stay.
• Performs other duties as assigned/required.

• Required:
  • Education: Doctor of Medicine Degree (M.D.) or Doctor of Osteopathic Medicine Degree (D.O.).
  • Experience: 2 years in a physician leadership role.
  • Licensure/Certification:
    • Current State MD or DO License and an ABMS (American Board of Medical Specialties) Certification.
    • AHA BLS.

• Preferred:
  • Education: Advanced degree in Business and/or Health Care Administration.
  • Experience:
    • Utilization Management and hospital committee chair
    • Demonstrated ability to work in a collegial role with members of the medical staff and to engage in education to hospital medical staff
    • Prefer successfully conducted physician to physician discussions with payers.

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