Physician Advisor

Job Summary and Responsibilities

As a Physician Advisor, you will promote evidence-based medical care and appropriate hospital resource utilization, facilitating communication across medical, nursing, care coordination, and administrative departments.

Every day you will advocate for efficient patient care, remove barriers, and collaborate with attending physicians, bolstering the Department of Care Coordination's utilization and compliance efforts.

To be successful, you need exceptional clinical acumen, strong communication, and a deep understanding of hospital operations/regulations. Your ability to influence, drive efficiency, and advocate will be paramount for optimizing care and resource allocation.

• Develops Relationships Shows a proactive willingness to engage in ambiguous or conflict situations. Respects physicians and strives to work collaboratively with the medical staff. After reviewing the Job Description, HR policies, UR Plan and other Case Management related documents, discusses expectations of the role with the accountable executive, administrators and the Case Management administrator. Meets with each staff person in the case management department to begin to establish a working relationship.
• Meets with key personnel in the business office, admitting, medical records (HIM), education, nursing, key physicians, and ancillary services. Develops relationships and meets with key individuals on the medical staff. Communicates teamwork, caring and compassion. Understands that negotiations, especially inside a medical staff, involve long-term relationships.
• Seeks Training / Information / Knowledge Communication courses such as 'Crucial Conversations'. Review current legal, ethical, medical by-laws and regulatory parameters that influence the organization, as well as the systems and staff in place to address them. Develops familiarity with the Inter Qual® or currently used criteria set. Attends formal training or seeks learning from the ACPE, ABQAURP, IHI, QIO or other authority on cost and quality.
  
  Participates in suggested training sessions.
• Participates in the Case Management Process including Utilization Review and Proactive Discharge Planning. Articulates case management as a specialty process in itself that reflects national standards of care. With the Director of Case Management, Executive Lead and Medical Staff Leadership, provides input, reviews and evaluates the organization-wide case management program. Part of a physician team responsible for daily availability for rounds and / or other daily case management and utilization review activities.
  
  Ensures that physicians covering the PA are familiar with the PA's approaches and provides follow-through, working as a team providing trade off information and feedback to each other. Provides secondary review and the application of medical rationale and decision making to referred cases and provides outcome of secondary review for documentation in the Utilization Review records (either paper or MIDAS/CERMe) of the individual patient.
  
  Participates in activities as needed to actively manage avoidable days and improve efficiency of consultations, tests and surgery scheduling, hospital and physician weekend efficiency, last minute discharges and over and under utilization. Leads, co-leads and advises competent leaders in case management activities, articulating the need that there should be responsibility assigned for next steps. When appropriate, uses a panel of physician experts in areas outside own expertise to bring specialty knowledge to bear on complex situations.
  
  Reviews and participates as necessary in the development and refinement of order sets, clinical paths, algorithms or protocols, core measures and other forms of structured care methodologies as requested. Works side by side with case manager, giving direction with criteria, educating on treatment flow, supporting case management to foster trust within medical staff. Communicates with fellow physicians with conviction and respect and resolves patient management issues or refers on to external review organization for review including the designated Quality Review Organization and external Medical Directors.
  
  The Physician Advisor in addition to assisting in the review of specific cases recognizes and trends Patterns of Physician utilization and communicates patterns and trends to the Utilization Management Committee and other Medical Staff Committees as indicated. Takes a proactive approach and follows up on actions requested of himself / herself by the case management team. Effectively participates in communication as needed with physicians, organizations, payers and IPA's in activities such as RAC appeals, audits and secondary review.
• Advises medical staff in and facilitates case management and utilization review communication with the medical staff. Articulates the importance of physicians' cooperation in working with the mission of the hospital and health system including stewardship,…