Physician Advisor

2310 AU Medical Center, Inc.•Augusta, GA

17d

About The Position

The Physician Advisor for WMCG in Augusta, Georgia reports to and is accountable to the Vice President / CMO. The role supports quality, utilization, patient satisfaction, and efficiency goals through performance improvement and education. Working with the Vice President / CMO and other WellStar Health System leaders, the Physician Advisor provides clinical consultation, supports appropriate and efficient use of healthcare resources, and helps the facility achieve its annual quality goals. The Physician Advisor works closely with Care Coordination and Care Management teams to assess medical necessity, level of care, length of stay, clinical documentation, and care transitions. The role provides timely feedback to physicians and care teams, supports denial management and readmission reduction, and helps address utilization, throughput, and resource-management issues. The position also supports quality and patient safety initiatives, regulatory reviews, utilization review activities, and ongoing education for physicians and other healthcare professionals. The role participates in a limited on-call schedule, providing phone and electronic consultation and chart review for Care Coordination teams across WellStar facilities. The Physician Advisor meets regularly with the CMO to review cases and targets related to cost, quality, and patient satisfaction, and may assist with customer service complaints at the CMO’s discretion. Other duties may be assigned, and the position must comply with WellStar Health System policies, standards of work, and code of conduct.

Requirements

Doctorate in Medicine (MD) or Doctorate in Osteopathic Medicine (DO).
MD or DO license and certification required upon hire.
Eight to ten 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 in emergency situations.
Ability to manage two to three activities concurrently on an ongoing basis.
Management skills to lead physicians effectively.
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 or management degree preferred.
Master of Health Administration preferred.
Board certification in specialty of practice preferred.
Healthcare Quality & Management Certification, such as ABQAURP or equivalent, preferred.

Responsibilities

Provide timely clinical consultation and expertise to Care Coordination and Care Management teams to support efficient and fiscally responsible resource use.
Assess clinical situations, medical necessity, appropriate level of care, length of stay, and inpatient versus outpatient observation status.
Support 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 denial management, including concurrent review when possible, and respond to requests involving payers, denials, appeals, admission decisions, observation status, transitions of care, 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 review of patients.
Review clinical records and work with Clinical Documentation Excellence Specialists on physician queries to support accurate documentation and substantiate medical necessity and level of care.
Work with hospital-based physician Medical Directors to address throughput, length of stay, excess days, and continuum-of-care barriers.
Support planning and development of care for specialized or complex patient populations and programs to manage patients across the continuum of care.
Work with the Quality Department to assess whether professionally 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, to identify trends and develop responses and improvement plans.
Participate in a limited on-call schedule, providing phone consultation and chart review for Care Coordination teams across WellStar facilities.
Provide ongoing education on payer and utilization matters, clinical practices and research, healthcare trends, collaborative initiatives, post-acute care capabilities, and hospital policies and operations.
Serve as a consultant to Care Management on structures that support effective service delivery and as an expert resource to physicians and hospital administration on clinical, quality, ethical, regulatory, and financial risks.
Lead or co-lead regularly scheduled Hospital-wide Complex Care Rounds.
Bring potential or actual problems in physician practices to the attention of the VPMA.
Advise on the development and use of clinical guidelines, order sets, pathways, and other structured care methods; consult physician experts in specialties outside the Advisor’s expertise as needed.
Assist the CMO and Director of Care Coordination with the Utilization Review Committee and coordination with other Performance Improvement committees.
Help identify opportunities related to market share, patient flow and capacity, disease-management support, and grants.
Work with the Quality and Patient Safety Department to help attain 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.
Maintain working knowledge of the Care Management Dashboard and physician profiles.
Perform other duties as assigned and comply with WellStar Health System policies, standards of work, and code of conduct.