Physician Advisor (MD/DO)

2510 Cobb Hospital, Inc.•Mableton, GA

13h

About The Position

The Physician Advisor for Wellstar Cobb Hospital reports to and is accountable to the Chief Medical Officer (CMO). The role advances quality, utilization, patient satisfaction, and efficiency through performance improvement and education initiatives. In collaboration with CMOs across the WellStar Health System, the Physician Advisor provides clinical consultation and expertise to Care Coordination/Care Management, physicians, and hospital administration. The Physician Advisor conducts clinical reviews of cases referred by Care Coordination/Case Management staff and other healthcare professionals, including cases involving commercial payers and Medicare Advantage plans. Reviews assess medical necessity, appropriateness and level of care, length of stay, documentation, regulatory compliance, and effective use of healthcare resources. The role provides timely feedback and follow-up to physicians and care teams, supports denial management and appeals, and helps address barriers in patient throughput and transitions of care. The Physician Advisor leads facility readmission-reduction initiatives, supports ongoing education about payer and utilization matters and best clinical practices, and collaborates with clinical and administrative leaders on performance improvement. The position also participates in quality and patient-safety work, complex-care rounds, utilization review activities, and limited on-call coverage for WellStar facilities. The Physician Advisor meets regularly with the CMO to review cases and targets related to cost, quality, and patient satisfaction.

Requirements

Doctorate in Medicine (MD) or Doctorate in Osteopathic Medicine (DO).
MD or DO license required upon hire.
Minimum of eight to ten years of clinical experience.
One to three years of post-residency Utilization Management experience, with focus on clinical documentation, medical necessity assessment, billing and coding acumen, business, strategic planning, financial planning, and development.
Ability to communicate and understand verbal and written English.
Positive attitude consistent with WellStar’s Credo.
Organizational skills to react and perform under stress and in emergency situations.
Ability to manage two to three activities simultaneously on an ongoing basis.
Management skills to effectively lead physicians.
Character and disposition that foster physician engagement.
Time-management skills to meet scheduled and unscheduled operational deadlines.
Analytical skills to prepare and manage a budget.
Availability for a limited on-call schedule, including phone consultation and electronic chart review.

Nice To Haves

Master of Business Administration/Management or Master of Health Administration.
Board certification in the specialty of practice.
Health Care Quality & Management certification, such as ABQAURP or equivalent.

Responsibilities

Provide timely clinical consultation and expertise to the Care Coordination/Care Management team to support efficient, fiscally responsible use of resources.
Assess clinical situations, medical necessity, and appropriate level of care; provide real-time feedback and communicate follow-up actions to physicians, care coordinators, social workers, nurses, and other involved personnel.
Assist with level-of-care and length-of-stay management, including inpatient versus outpatient observation status, compliance with the 2 MN Rule, throughput initiatives, and care transitions.
Lead facility readmission-reduction initiatives with the Chairperson of the Readmission PIC and in collaboration with the CMO.
Assist with concurrent denial management when possible and respond to requests involving payers, denials, appeals, observation status, admissions, transitions of care, end-of-life dilemmas, and termination-of-benefits notifications.
Work with Care Coordination leadership to expedite case-management issues and manage work queues.
Review and suggest improvements to resource and service management; assist staff with clinical reviews.
Review clinical records for accurate documentation supporting medical necessity and level of care, and work with Clinical Documentation Excellence Specialists on physician queries and clinical-criteria clarification.
Collaborate with hospital-based physician Medical Directors to address throughput, length of stay, excess days, and continuum-of-care barriers.
Participate in the development and planning of care for specialized or complex-care patient populations and develop programs to support patient care across the continuum.
Work with the Quality Department to assess whether professionally recognized quality-care standards are met and refer matters to Peer Review when appropriate.
Review reports from regulatory agencies, including RAC audits and QIO reports, to identify trends and help develop responses and improvement plans.
Participate in a limited on-call schedule, providing phone and electronic consultation and chart review for Care Coordination teams across WellStar facilities.
Support planned, ongoing education for physicians, physician assistants, nurse practitioners, medical students, and others on payer and utilization matters, best practices, healthcare trends, post-acute capabilities, and hospital policies and operations.
Consult with the Care Management Department to support an effective and efficient service structure.
Serve as an expert resource to physicians and hospital administration on decisions involving quality, ethical, regulatory, or financial risks.
Lead or co-lead regularly scheduled Hospital-wide Complex Care Rounds, ideally weekly.
Bring potential or actual problems in physician practices to the CMO’s attention.
Provide clinical expertise on established clinical guidelines, order sets, pathways, and other structured care methodologies as requested.
Consult physician experts in specialties outside the Physician Advisor’s expertise for complex clinical resource situations, and apply continuous quality improvement principles to improve physician and hospital practice.
Assist the CMO and Director of Care Coordination with Utilization Review Committee activities and coordination with other Performance Improvement committees.
Identify organizational opportunities involving market share, patient flow and capacity, disease-management support, and grants.
Work with the Quality and Patient Safety Department to support hospital goals and perform other duties reasonably requested by the CMO.
Meet regularly with the CMO to review cases and revise cost, quality, and patient-satisfaction targets; assist with customer-service complaints as needed and at the CMO’s discretion.
Maintain working knowledge of the Care Management Dashboard and physician profiles.