Additional Job Description:

Position Summary:  The Physician Advisor for Utilization Management of WVU Medicine works closely with the medical staff leadership, the entire medical staff including resident physician house staff, all areas of resource management, case management, social services, discharge planning, and utilization management to develop and implement methods to optimize use of hospital services for all patients.  This includes working with hospital leadership in developing utilization management protocols with physicians and others to optimize length of hospital stay and efficient management of resources, insuring patients are in the appropriate level of care, supporting documentation, and monitoring the appropriate use of diagnostic and therapeutic modalities. 

The Physician Advisor will work with the Chief to help him/her lead and direct WVU Medicine’s pursuit of the highest possible standard of patient care, clinical effectiveness, and financial soundness.  The Physician Advisor will support the mission by using he/her voice to represent the opinion of medical staff, third party payers, and regulatory bodies and in helping the medical staff understand the rationale for administrative decisions and in so doing, develops reciprocal loyalty. 

The Physician Advisor will report to the Chief who will report and be accountable to the Chief Medical Officer.

Essential Duties and Responsibilities:

Administrative:

Provides regular input into the strategic planning and resource allocation processes of WVU Medicine as it applies to Utilization Management.

Conducts physician education sessions to share data, trends, practice patterns, and other relevant information as requested.

Investigates avoidable delay concerns referred by case management & utilization management staff that effect patients’ outcomes during their hospital stay.  Investigates and studies new developments in medical practice models, regulatory requirements, and third party coverage as assigned by the Chief. 

Participates in the development and implementation of new patient care programs, and consideration of hospital/medical staff ventures. 

Identifies denial trends and works with the medical staff and hospital administration to resolve the issue.  Reports practice pattern trends and opportunities to service line or department specific meetings at the request of the CMO or hospital leadership. 

The Physician Advisor will be required to submit quarterly time sheets verifying successful completion of the number of contractually agreed upon hours to this pursuit. 

He/she will be a credentialed member of all system hospitals.  The physician advisor will travel to and be a consulting representative.  He/she will also represent Utilization Management at various hospital assigned committees. 

Other duties may be assigned.

Medical Staff:

Assures medical staff compliance with medical staff bylaws, rules, and regulations policies and procedures as they pertain to utilization management.  In concert with the Chief receives, investigates, and where possible resolves conflicts related to Utilization Management.

Provides education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources, and alternative level of care.

Provides education to physicians and other clinicians regarding inappropriate admissions.

 Regulatory Organizations:

Assists WVU Medicine and related affiliated operations in meeting regulatory guidelines, licensure requirements, and in achieving quality improvement objectives.  Maintains an awareness of regulatory standards guidelines as well as clinical standards for federal programs and state licensure requirements, including proposed changes.  Maintains an awareness of regulations, policies, procedures, and standards for third party payers.

Information Systems:

Participates in information technology development to allow feedback to physicians regarding practice patterns, and performance and resource utilization.  Assures proper analysis of data occurs to identify patterns and trends, and ensures reporting of the ongoing results.

Clinical Responsibilities:

The Physician Advisor will be expected to dedicate the time stipulated in their contract to the successful performance and completion of the above referenced administrative duties.  Clinical responsibilities will be at the discretion of the home clinical department.

Minimum Qualifications:

Doctorate of Medicine from an accredited School of Medicine or Osteopathy and board certified by a board recognized by the American Board of Medical Specialties. 

Holds or eligible for Medical licensure in the State of West Virginia.

Minimum 5 years clinical experience in the practice of medicine is preferred.

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center: