Physician Advisor

Overview

ST. CHARLES HEALTH SYSTEM

JOB DESCRIPTION

TITLE: Physician Advisor

REPORTS TO POSITION: Medical Director Care Coordination

DEPARTMENT: Administration

DATE LAST REVIEWED: July 2025

OUR VISION: Creating Americas healthiest community, together

OUR MISSION: In the spirit of love and compassion, better health, better care, better value

OUR VALUES: Accountability, Caring and Teamwork

DEPARTMENT SUMMARY: The Administration department oversees clinical operational excellence within St. Charles Health System. This includes engagement with Safety and Quality departments, Medical Staff Affairs, Hospital operations, and Education and Research.

The Physician Advisor is a key member of the healthcare organizations leadership team and is charged with meeting the organizations goals and objectives for assuring the effective, efficient utilization of health care services. The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care coordination and utilization review departments and the hospital leadership. The Physician Advisor shall develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, and appropriate physician documentation requirements.

This position does not directly manage other caregivers.

ESSENTIAL FUNCTIONS AND DUTIES:

• Works closely with the medical staff leadership, the entire medical staff, including resident physician house staff, all areas of resource management, care coordination, social services, discharge planning, and utilization management to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided.
• Works with hospital leadership in developing care coordination protocols with physicians and others to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.
• Maintains confidentiality of patient care and business matters. Adheres to all professional and performance expectations set forth within the medical staff bylaws, rules & regulations and complies with all St. Charles Health System established policies and procedures.
• Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to utilization management, care coordination, and other related areas as requested.
• Obtains familiarity and working knowledge of standard published criteria such as MCG/Inter Qual and applies professional judgment and patient specific variables as may be necessary or justifiable.

• Maintains accountability for achieving care coordination outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care.
• Reviews issues identified by case managers to ensure appropriate follow-up, recommend improvement initiatives as needed, and make referrals to the appropriate department chair, as necessary.
• Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the care coordination department in a timely fashion.
• Provides consultation to nurses and care coordination staff regarding complex clinical issues. Advises on justification required for continued stay, medical necessity and utilization management.

• Reviews medical records of patients identified by case managers or as requested by the healthcare team to perform quality and utilization oversight.
• Performs medical necessity reviews including initial level of care, secondary reviews, and continued stay reviews. Assists with length of stay management and utilization of resources. Reviews and makes suggestions related to resource and service management.
• Performs reviews for determining…