Job Details

POSITION PURPOSE/SUMMARY:

• Purpose: Provides physician leadership and expertise related to care coordination, length of stay (LOS)/level of care (LOC) management, care variation management, patient flow/throughput management, ancillary service utilization (e.g., lab and radiology) and clinical documentation improvement (CDI).
• Policy-Setting Responsibilities: Responsible for reviewing and providing physician perspective for policies that relate to care coordination, care progression, patient access, care variation management and CDI.
• Decision-Making Authority: Responsible for collaborating with the care coordination, nursing, patient access, ancillary services, and CDI departments to meet established goals and for leading physician participation and compliance with responsibilities.
• Supervisory Responsibility: Responsible for engaging physicians in care coordination, care progression, patient access, care variation management and CDI activities in alignment with the Physician Advisor’s assigned facility, as well as to support system-level goals.

DUTIES AND RESPONSIBILITIES:

Inpatient Clinical Optimization: Care Coordination, Progression and Variation

• Serves as physician expert and provides support to care team and care coordination staff regarding utilization decisions including screening for appropriateness of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource utilization/management, denial management issues, discharge planning (DP) advice, and quality issues.
• Maintains knowledge of government regulations related to utilization review, transition planning, billing, and managing patients and acts as a resource to physicians and staff related to these regulations.
• Perform second level reviews, peer-to-peer calls and advise on continued stay reviews that require additional Physician Advisor input.
• Management of appeals process, post-discharge review, and necessary documentation improvement.
• Interacts with medical staff by seeking additional clinical information from physicians, discussing patients’ needs, suggesting alternative treatment options, and recommending next steps.
• Functions as a consultant and resource to primary (attending) physicians. Reinforces evidenced-based medicine best practices and adherence to reduction in clinical variation.
• Supports care team, patient placement department and nursing supervisors by assisting with patient placement decisions (as needed), care/discharge delays, and patient throughput.
• Provides support to ancillary services departments (e.g., lab and radiology) by mitigating the inappropriate or unnecessary use of services.
• Participates in daily Escalation Huddles to support care team communication and coordination activities, and to discuss selected cases (e.g., outliers or care/discharge barriers) and makes recommendations regarding care.
• Prepares for and participates in (or ideally, leads) monthly Utilization Management (UM) Committee.
• Documents patient care reviews, determinations, and other pertinent information per hospital/care coordination policies.
• Maintains a consistent professional presence at facility campus to support medical staff and perform daily responsibilities.

Clinical Documentation Improvement

• Provides expertise to CDI specialists, enhancing query processes and physician engagement to ensure medical documentation accurately reflect patient care complexity.
• Designs and conducts educational programs for medical and CDI staff, updating training to include the latest clinical guidelines and coding standards.
• Reviews and advises on medical records to ensure documentation quality, addressing gaps and aligning with regulatory and billing standards.
• Develops strategic CDI initiatives aligned with healthcare quality goals and provides clinical expertise on complex cases and documentation standards.

STANDARDS OF BEHAVIOR

I. Confidentiality

• Demonstrates knowledge of and compliance with all regulatory privacy standards (e.g., HIPAA, Joint Commission).
• Maintains patient and organizational confidentiality by safeguarding information and sharing only on a need-to-know basis.

II. Professionalism

• Maintains consistent attendance, punctuality, and professional appearance in accordance with hospital policy.
• Demonstrates a positive attitude and fosters a supportive, constructive work environment.
• Acts as a mentor and lifelong learner; remains approachable and supportive while upholding the hospital’s mission and vision.
• Understands role limitations, participates in performance improvement initiatives, and maintains knowledge of hospital systems and processes.

III. Communication

• Creates a welcoming environment for patients, visitors, and staff, both in person and by phone.
• Demonstrates active listening by remaining attentive, avoiding interruptions, seeking clarification, and acknowledging understanding.
• Communicates clearly, courteously, and respectfully, using a calm and professional tone.

IV. Accountability

• Takes responsibility for actions by providing accurate and transparent information and responding promptly to requests.
• Communicates timely and accurate updates regarding patient and unit status.
• Adheres to hospital policies and professional standards, including dress code, punctuality, and expected behaviors.
• Respects the property of others and demonstrates cultural awareness and sensitivity.

V. Teamwork

• Maintains a clean and professional work environment.
• Communicates needs effectively with coworkers and leadership.
• Understands the impact of individual responsibilities on overall team function.
• Resolves conflicts constructively and seeks mutually beneficial solutions.
• Demonstrates appreciation and recognition of others through words and actions.

Minimum Qualification

• Education: Graduate of an accredited medical school. Additional education in quality and utilization management through continuing medical education programs and self-study preferred.
• Experience: Minimum of five years recent experience in clinical practice. Utilization management experience as a member of the UM oversight committee or past Physician Advisor experience preferred.
• Physical Demands: Ability to travel to various patient care areas, conference facilities, corporate offices or other sites as requested.
• Supervision Received: Corporate Care Management Leader for Administrative supervision

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidates qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.