Physician Advisor (MD/DO)

Wellstar Health System•Marietta, GA

About The Position

The Physician Advisor (PA) reports to and is accountable to the Chief Medical Officer (CMO). The role supports quality, utilization, patient satisfaction, and efficiency goals through performance improvement and education initiatives. In collaboration with CMOs across the WellStar Health System, the PA provides clinical review and consultation on referred cases to assess appropriateness of care, medical necessity, and level of care, while supporting effective and efficient use of health care services and regulatory compliance. The PA works closely with Care Coordination and Care Management, physicians, advanced practice professionals, nursing and ancillary personnel, and administrative leaders. The position addresses length of stay, throughput, readmissions, denials, documentation, care transitions, and resource stewardship. It also provides education on payer and utilization matters, clinical best practices, health care trends, post-acute care capabilities, and hospital policies and operations. The PA participates in a limited on-call schedule, providing phone and electronic consultation and chart review for Care Coordination teams across WellStar facilities.

Requirements

Doctorate in Medicine (MD) or Doctorate in Osteopathic Medicine (DO).
MD or DO license and credential required upon hire.
Minimum 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, and 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.
Board certification in specialty of practice.
Health Care Quality & Management Certification, such as ABQAURP or equivalent.

Responsibilities

Provide timely consultation and clinical expertise to Care Coordination/Care Management regarding clinical status, medical necessity, level of care, resource utilization, and follow-up actions.
Assist with level-of-care and length-of-stay management, including inpatient versus observation status, compliance with the 2 MN Rule, throughput initiatives, and care transitions.
Lead facility readmission-reduction initiatives with the Readmission PIC chairperson and in collaboration with the CMO.
Assist with concurrent denial management and respond to requests involving payers, denials and appeals, observation status, admission decisions, transitions between levels 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 resource and service management and assist staff with clinical review of patients.
Review clinical records for accurate documentation supporting medical necessity and level of care; collaborate 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 continuum-of-care barriers.
Participate in planning care and developing programs for specialized or complex-care patient populations and their management across the continuum of care.
Work with the Quality Department and available resources to assess whether recognized standards of quality care are met, referring matters to Peer Review when appropriate.
Review reports from regulatory agencies, including RAC audits and QIO reports, help identify trends, develop responses, and create improvement action plans.
Participate in a limited on-call schedule and provide phone consultation and chart review for Care Coordination teams at WellStar facilities.
Support ongoing education for physicians, physician assistants, nurse practitioners, medical students, and others on payer and utilization matters, best clinical practices, health care trends, collaborative initiatives, post-acute care capabilities, and hospital policies and operations.
Serve as a consultant to Care Management on hospital structures that enable efficient and effective service delivery.
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, as requested, on established clinical guidelines, order sets, pathways, and other structured care methodologies; draw on physician experts in specialties outside the PA'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.
Identify opportunities to increase market share, flow, capacity, disease-management support, and grant acquisition.
Meet regularly with the CMO to review cases and revise cost, quality, and patient-satisfaction targets; assist with customer-service complaints as requested by the CMO.
Maintain working knowledge of the Care Management Dashboard and physician profiles.
Perform other duties reasonably requested by the CMO.
Work with the Quality and Patient Safety Department to help attain hospital goals.