Physician Advisor (MD/DO)

Wellstar Health System•Roswell, 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 consultation on utilization management, medical necessity, level of care, documentation, resource stewardship, and care transitions. The PA works closely with Care Coordination and Care Management, physicians, advanced practice professionals, nursing and ancillary staff, and administrative leaders. The position supports readmission-reduction efforts, denial management, throughput and length-of-stay improvement, regulatory compliance, quality initiatives, and the efficient management of patients across the continuum of care. The PA also contributes to ongoing education for clinicians and others on payer and utilization matters, clinical practices, healthcare trends, post-acute care capabilities, and changes in hospital policies and operations. The role includes participation in a limited on-call schedule with colleagues. The PA must be available by phone and electronically to consult and review charts for Care Coordination teams at WellStar facilities. The PA 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/certification 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, and financial planning and development.
Ability to communicate and understand verbal and written English.
Positive attitude consistent with WellStar’s Credo.
Organizational skills to 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/Management or Master of Health Administration.
Board certification in specialty of practice.
Healthcare Quality & Management Certification, such as ABQAURP or equivalent.

Responsibilities

Provide timely clinical consultation to Care Coordination and Care Management teams on medical necessity, appropriate level of care, resource utilization, and follow-up actions.
Assist with level-of-care and length-of-stay management, including inpatient versus outpatient observation status, compliance with the Two-Midnight 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.
Work with Care Coordination leadership to expedite case-management issues and manage work queues.
Review and recommend changes regarding resource and service management; assist staff with clinical reviews 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-criteria clarification.
Collaborate with hospital-based physician medical directors on throughput, length of stay, excess days, and continuum-of-care barriers.
Participate in 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 recognized standards of quality care 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 consultation and chart review for Care Coordination teams across WellStar facilities.
Support ongoing education for physicians, advanced practice professionals, medical students, and others on payer and utilization topics, clinical practices, healthcare trends, post-acute capabilities, and relevant hospital policies and operations.
Consult with Care Management on hospital structures that support effective and efficient service delivery.
Respond to requests involving payers, denials and appeals, observation status, admissions, care transitions, end-of-life dilemmas, and notices such as HINNs or other termination-of-benefits notifications.
Advise physicians and hospital administration on decisions that may involve 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 guidelines, order sets, pathways, and other structured care methodologies as requested; draw on physician experts in specialties outside the PA’s expertise when needed.
Promote continuous quality improvement in physician and hospital practice.
Assist the CMO and Director of Care Coordination with Utilization Review Committee activities and coordinate those activities with other Performance Improvement committees.
Participate in identifying opportunities involving market share, patient flow and capacity, disease-management support, and grants.
Work with the Quality and Patient Safety Department to support attainment of hospital goals.
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.
Perform other duties reasonably requested by the CMO.