Job Summary: The Physician Advisor reports to and is accountable to the Chief Medical Officer to impact quality, utilization, patient satisfaction and efficiency metrics through Performance Improvement and education initiatives that will enable the facility to achieve its stated goals. Working in collaboration with the CMO(s) in the WellStar Health System (WHS), the Physician Advisor (PA) will be involved in the following areas:
Utilization Management: The Physician Advisor (PA) will conduct clinical review on cases for commercial payers and medicare advantage plans that are referred by Care Coordination/Case Management staff and/or other health care professionals to assess for appropriateness of care; proper level of care in accordance with hospital objectives for assuring quality patient care and effective, efficient utilization of health care services, and to meet regulatory requirements. Working as a peer to physicians and as a consultant to Care Management and administration, the PA intervenes when practice patterns or behaviors or documentation issues create disparity between pathway standards, intensity of service, severity of illness, patient and family rights, teamwork, or other issues regarding the stewardship of resources for individual patients, diagnostic populations, and the organization as a whole. In the area of Readmissions, the Physician Advisor will help to lead the effort to reduce avoidable readmissions. The Physician Advisor will engage with Physicians, Advanced Practice Professionals, nursing and other ancillary personnel as well as administrative leaders as part of his/her role in Performance Improvement, Resource Utilization and ongoing education on imp8ortant trends in healthcare management. Quality Improvement: In addition to the above duties, the PA will work with the CMO and the Quality Director or Manager at the hospital on quality improvement initiatives to assist the hospital to achieve its annual goals.
Required Minimum Education:- Doctorate Medicine or Doctorate Osteopathic Medicine
- Masters Business Administration/Management-Preferred or Masters Health Administration-Preferred
Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated.
- DO - Doctor of Osteopathic Medicine or MD - Medical Doctor
Additional License(s) and Certification(s):- Board certified in specialty of practice preferred
- Health Care Quality & Management Certification, (i.e. ABQAURP or equivalent) preferred
Required Minimum Experience:- Minimum 8 years 8-10 years clinical experience Required Minimum
- 1 year One (1) to three (3) years of experience post residency in Utilization Management experience with focus on clinical documentation, medical necessity assessment, billing and coding acumen, business, strategic planning, financial planning and development.
