Physician - Physician Advisor Utilization Management - Corporate

Corewell Health • Southfield, MI

1d • Hybrid

About The Position

Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. The Physician Advisor collaborates with the Utilization and Care Management Departments, Organization Leadership as well as with staff physicians to ensure compliance with the organizational Utilization Management Plan.

Requirements

• Doctorate. Required
• License -Physician (MD) - State of Michigan Upon Hire required Or
• License -Osteopathic Physician (DO) - State of Michigan Upon Hire required

Nice To Haves

• CRT-DEA Registration - State of Michigan. Preferred
• CRT Physician Advisor Certification- American College of Physician Advisors within one-year Preferred
• CRT Physician Advisor Sub-Specialty certification (CHCQM-PHYADV)- American Board of Quality Assurance and Utilization Review Physicians within one-year Preferred
• CRT ACMA Physician Advisor Certification- American Case Management Association/Association for Physician Leadership in Care Management (APLCM) within one-year Preferred

Responsibilities

• Develop and cultivate positive and productive working relationships with other Corewell Health personnel, and promote a culture of safety, teamwork, compassion, collaboration, clarity, curiosity, and courage.
• Demonstrate a commitment to service and distinctive, personalized care with both internal customers (coworkers, fellow employees, hospital staff, etc.) and external customers (patients, family members, referring physicians/specialists, etc.), while striving to exceed customer expectations.
• Assist in meeting operational, financial, and patient satisfaction goals.
• Timely completion of all specific competencies and annual organizational mandatories.
• Collaborate with the Utilization and Care Management Departments as well as physicians to provide improved accuracy of determining patient status upon hospital entry.
• Collaborate to provide improved management of observation patients including reviews for consideration of early discharge or change to inpatient status.
• Collaborate to provide improved timeliness of case reviews not meeting utilization management screening for inpatient criteria.
• Collaborate to provide improved management of concurrent utilization management denials.
• Act as a consultant and resource to the medical staff regarding federal and state utilization and quality regulations relative to appropriateness of hospitalization, continued stay, and use of resources.
• Provide feedback to attending and consulting physicians regarding level of care, length of stay, and quality issues.
• Seek additional clinical information from the attending and consulting physicians.
• Recommend and request more complete medical record documentation.
• Participate in review of long stay patients, in conjunction with the Care Management Leadership, Care Management Team and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care.
• Act as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate.
• Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization, and alternative levels of care.
• Participate in on-call and weekend coverage, as required by the Department.
• Document in the patient’s medical record in a manner consistent with hospital, payor, and regulatory standards.
• Actively participate in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

• Job Type: Part-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree