PHYSICIAN ADVISOR- UTILIZATION MANAGEMENT & PHYSICIAN ADVISORY SERVICES

Cook County Health • Chicago, IL

229d • $299,943 - $338,952

About The Position

The Physician Advisor 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 while also ensuring the quality of care provided. This includes working with hospital leadership in developing care management protocols with physicians and others to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.

Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school.
• Must be licensed as a physician in the State of Illinois or have the ability to obtain Illinois physician licensure prior to starting employment.
• Board Certification in clinical area of expertise.
• Three (3) years of clinical practice experience in a large health care system or group practice.
• Two (2) years of experience using an integrated electronic medical record.
• One (1) year of experience in Utilization Management.
• Current Health Care Quality and Management Certification (CHCQM) or the ability to obtain certification within one year of employment.

Nice To Haves

• Three (3) years of experience working in a multispecialty group practice.
• Two (2) years of experience using a large scale EMR platform (e.g. Cerner, EPIC).
• Current Physician Advisor Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).

Responsibilities

• Provides one-on-one provider education on quality, utilization review, and documentation improvement.
• Works closely with the Director of Inpatient Utilization and Case Management to oversee utilization management professional and support staff.
• Collaborates with care coordination leadership to improve discharge planning, throughput, length of stay, readmission rates, and care transitions.
• Facilitates strong working relationships between providers, nursing, clinical documentation specialists, case managers, utilization review staff, coding, and management.
• Reviews the utilization of resources and objectively measures outcomes for inpatient and observation stays.
• Reviews cases referred by the denials team and presents the hospital's case to third party payer Medical Director or Peer Review Board.
• Maintains an active clinical workload of at least 50%.
• Participates in Daily Interdisciplinary Rounds (IDR) with the Healthcare Team.
• Identifies barriers to timely discharge and assists with developing solutions.
• Provides regular feedback to physicians regarding level of care, length of stay, and potential quality issues.
• Acts as a liaison with payers to facilitate approvals and prevent denials.
• Provides education to medical staff on new clinical practice guidelines and regulatory requirements.
• Evaluates Clinical Documentation Improvement (CDI) metrics by Physician performance profiling.
• Develops structure and implements a CDI integrity program.

Benefits

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan
• Deferred Compensation Program
• Paid Holidays, Vacation, and Sick Time
• Public Service Loan Forgiveness Program (PSLF)

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Hospitals
• Education Level: Bachelor's degree