Physician Advisor (MD/DO)

Wellstar Health System•Austell, GA

About The Position

The Physician Advisor for Wellstar Cobb Hospital reports to and is accountable to the Chief Medical Officer. The role supports quality, utilization, patient satisfaction, and efficiency goals through performance improvement and education initiatives, in collaboration with the CMO and other Wellstar Health System leaders. The Physician Advisor works with Care Coordination and Care Management to review referred cases, assess medical necessity and appropriate level of care, support efficient resource use, and provide timely clinical consultation and clear follow-up communications. The role addresses length of stay, observation versus inpatient status, denial management, readmissions, clinical documentation, care transitions, and barriers to throughput. It also supports staff with clinical reviews and collaborates with documentation specialists, hospital physician medical directors, the Quality Department, and other clinical and administrative teams. The Physician Advisor contributes to ongoing education for clinicians and other personnel on payer and utilization matters, best practices, healthcare trends, post-acute capabilities, and hospital policies. The role consults on payer interventions, denials and appeals, admission and care-transition decisions, end-of-life dilemmas, and other complex clinical, ethical, regulatory, or financial situations. The Physician Advisor may lead or co-lead Complex Care Rounds, assist with utilization review and performance improvement committees, support hospital quality and patient-safety goals, and participate in a limited on-call schedule for Wellstar facilities. The Physician Advisor meets regularly with the CMO to review cases and objectives and may assist with customer service complaints as needed.

Requirements

Doctorate in Medicine (MD) or Doctorate in Osteopathic Medicine (DO) is required.
MD or DO license is required.
Minimum of eight to ten years of clinical experience is required.
One to three years of post-residency Utilization Management experience is required, with a 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 emergency situations.
Ability to manage two to three activities concurrently 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.

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 Care Coordination/Care Management to support efficient and fiscally responsible use of resources.
Assess clinical situations, medical necessity, and appropriate level of care, and communicate feedback and follow-up actions to physicians, care coordinators, social workers, nurses, and other involved staff.
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 denial management, preferably on a concurrent basis.
Work with Care Coordination Leadership to expedite case-management issues and manage work queues.
Review and make recommendations regarding resource and service management.
Assist staff with clinical review of patients.
Review clinical records for appropriate and accurate documentation supporting medical necessity and level of care.
Collaborate with Clinical Documentation Excellence Specialists on physician queries and clinical-criteria clarification.
Work with hospital-based physician Medical Directors on throughput, length of stay, excess days, and continuum-of-care barriers.
Participate in developing and planning care for specialized populations or patients requiring complex disease and care management.
Plan and develop programs to facilitate management of patient populations across the continuum of care.
Work with the Quality Department and available resources to assess whether professionally recognized quality standards are met, referring matters to Peer Review when appropriate.
Review regulatory agency reports, such as RAC audits and QIO reports, identify trends, help prepare responses, and develop improvement action plans.
Participate in a limited on-call schedule and provide phone and electronic consultation and chart review for Care Coordination teams across Wellstar facilities.
Support planned, ongoing education for physicians, advanced practice professionals, medical students, and others on payer and utilization matters, clinical practices, healthcare trends, post-acute capabilities, hospital policies, and related subjects.
Consult with Care Management to support an adequate hospital structure for effective service delivery.
Respond to requests involving payer interventions, denials and appeals, observation status, admission decisions, transitions between levels of care, end-of-life dilemmas, and termination-of-benefits notifications.
Advise physicians and Hospital administration on decisions involving potential 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, as requested, on clinical guidelines, order sets, pathways, and other structured care methodologies.
Consult physician experts in specialties outside the Physician Advisor’s expertise for complex clinical resource matters and apply continuous quality improvement principles.
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.
Meet regularly with the CMO to review cases and revise cost, quality, and patient-satisfaction targets; assist with customer service complaints when requested by the CMO.
Maintain working knowledge of the Care Management Dashboard and physician profiles.
Perform other duties reasonably requested by the CMO.