Physician Advisor (MD/DO)

Wellstar Health System•LaGrange, GA

About The Position

The Physician Advisor reports to and is accountable to the Chief Medical Officer (CMO), supporting quality, utilization, patient satisfaction, and efficiency metrics through performance improvement and education. In collaboration with CMOs across the WellStar Health System, the Physician Advisor provides clinical review and consultation on cases referred by Care Coordination/Case Management staff and other healthcare professionals. The role assesses appropriateness of care, medical necessity, and level of care, while supporting quality patient care, efficient use of resources, and regulatory compliance. The Physician Advisor works as a physician peer and consultant to Care Management and administration. The role addresses practice patterns, behaviors, and documentation issues that may affect care pathways, service intensity, severity-of-illness determinations, patient and family rights, teamwork, or resource stewardship. The Physician Advisor also leads or supports readmission-reduction efforts, performance improvement, resource utilization, and ongoing education for physicians and other healthcare professionals. The position works closely with Care Coordination/Care Management, the CMO, hospital-based medical directors, quality and patient safety teams, and other leaders. It includes participation in a limited on-call schedule, with availability by phone and electronically to support Care Coordination teams across WellStar facilities through consultation and chart review.

Requirements

Doctorate in Medicine (MD) or Doctorate of Osteopathic Medicine (DO) required.
MD or DO license required.
Minimum of 8 to 10 years of clinical experience required.
One to three years of post-residency Utilization Management experience required, 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 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.

Nice To Haves

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

Responsibilities

Provide timely clinical consultation to Care Coordination/Care Management on referred cases, including concurrent assessment, medical necessity, and appropriate level-of-care determinations.
Give real-time feedback and communicate next steps to physicians, care coordinators, social workers, nursing staff, 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, payer interventions, and denial and appeals processes.
Work with Care Coordination Leadership to expedite case-management issues and manage work queues.
Review and recommend improvements to resource and service management; assist staff with clinical review of patients.
Review clinical records for accurate documentation supporting medical necessity and level of care; work with Clinical Documentation Excellence Specialists on physician queries and clinical clarification.
Work with hospital-based physician medical directors to address throughput, length of stay, excess days, and barriers across the continuum of care.
Participate in developing and planning care for specialized or complex-care patient populations and develop programs to support management across the continuum of care.
Work with the Quality Department to assess whether professionally recognized standards of quality care are met and refer matters to Peer Review when appropriate.
Assist in reviewing regulatory agency reports, including RAC audits and QIO reports, identifying trends, developing responses, and planning improvement actions.
Participate in a limited on-call schedule, providing phone and electronic consultation and chart review for Care Coordination teams across WellStar facilities.
Support ongoing education for physicians, physician assistants, nurse practitioners, medical students, and others on payer and utilization matters, clinical practices, healthcare trends, collaborative initiatives, post-acute care capabilities, and hospital policies and operations.
Consult with Care Management on hospital structures that support effective and efficient service delivery.
Respond promptly to requests involving payer issues, observation status, admission decisions, transitions between levels of care, end-of-life dilemmas, HINNs or other termination-of-benefits notifications, and related matters.
Advise physicians and hospital administration on decisions involving quality, ethics, regulatory compliance, or financial risk.
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; draw on physician experts in specialties outside the Physician Advisor’s expertise when needed.
Apply continuous quality improvement principles to improve physician practice and hospital practice.
Assist the CMO and Director of Care Coordination with Utilization Review Committee activities and coordination with other Performance Improvement committees.
Help identify opportunities to increase market share, patient flow and capacity, disease-management support, and grant acquisition.
Work with the Quality and Patient Safety Department to help achieve hospital goals.
Meet regularly with the CMO to review cases and revise cost, quality, and patient-satisfaction targets; assist with customer-service complaints as requested and at the CMO’s discretion.
Maintain working knowledge of the Care Management Dashboard and physician profiles.
Perform other duties reasonably requested by the CMO.