Job Information

AdventHealth Physician Advisor, Medical Staff Strategy in Bolingbrook, Illinois

Description

PLEASE NOTE: YOU ARE REQUIRED TO UPLOAD RESUME, LICENSURE/CERTIFICATION WITH YOUR APPLICATION!

All the benefits and perks you need for you and your family:

  • Benefits from Day One

  • Paid Days Off from Day One

  • Whole Person Wellbeing Resources

  • Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Part Time

Shift : Days

Location: Bolingbrook Hospital

The role you’ll contribute:

The Physician Advisor provides primary support for Care Management (CM) and secondary support for Clinical Documentation Integrity (CDI) and Quality departments and serves as a liaison between UM and CM teams and medical staff, as well as, the medical liaison for payor escalations. The Physician Advisor is responsible for educating, informing and advising members of the Utilization Management, Care Management, Clinical Documentation, Managed Care and Revenue Cycle departments and applicable medical staff, as well as collaborating with other disciplines to assist in the improvement of clinical documentation, patient safety, and quality outcomes.

Through support of Utilization Management, the Physician Advisor is responsible for providing clinical review of utilization, claims management, and quality assurance related to inpatient care, outpatient care/observation stays and referral services. The Physician Advisor is an important contact for clinicians, external providers, contracted health insurance payors, and regulatory agencies. This individual also serves as the subject matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient focused and cost-effective medical care.

The value you’ll bring to the team:

  • Provides clinical support/validation for Care Management, CDI and Quality teams

  • Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care Management structures, and functions and use of clinical guidelines

  • Develops and facilitates productive internal/external relationships with all physicians and constituents of Utilization Management, Care Management and CDI departments

  • Provides suggested approaches to clarifying clinical questions when Utilization Management and Care Management staff interact with physicians, nurses, or other health professionals

  • Maintains a positive and supportive relationship between the inpatient facilities, payors and physicians (hospitalist groups and primary care providers), and acts as the interdepartmental liaison for ACO activities and program development

  • Provides guidance to clinical questions from Utilization Management staff involved in authorizations, concurrent review, and denials as a back up to UM Physician Advisory as and when needed

  • Assists with interpretation of specific application of medical necessity criteria

  • Responsible for reviewing Clinical Documentation and performs secondary review for escalations

  • Evaluates and reviews charts for Quality indicators as part of QSR process within CDI

  • Assists in formulation of reasonable clinical arguments to address any questions regarding level of care

  • Chair of Readmission Committee

  • Chair of Utilization Management Committee

  • Performs peer-to-peer discussions with payer Medical Directors and/or discusses cases with payer representatives to facilitate claim resolution and build payer relationships when needed

  • Report and collaborates with Chief Medical Officers and acts as a liaison between Care Management and the Hospital’s Medical Staff

  • Reviews key performance indicators and progress to targets; reviews data and trends to identify opportunities for Length of Stay improvement to positively influence practice patterns and address avoidable delays

  • Serves as a resource for the Utilization Management (UM) Committee and shares observations, information and trends identified through data and case reviews

  • Conducts regular, ongoing meetings with Care Management to ensure continuity and efficiency in the inpatient setting, as well as, educate on common problematic clinical issues

  • Provides guidance to clinical questions from Care Management staff regarding appropriateness of placement in terms of patient’s clinical status/care needs

  • Supports long stay meetings to effectively manage length of stay. Generates clinically sound alternative ideas and approaches to complex and/or long stay patients

  • Provides multidisciplinary, “big picture” approaches that coordinate clinical, psychosocial, payor, financial and other needs

  • Promotes communication of expected discharge date with multidisciplinary team, patients and families

  • Collaborates with Clinical Documentation Integrity leadership and meets at least quarterly to assist in the identification of clinical documentation improvement opportunities

  • Collaborates with Quality and Patient Safety leadership and meets at least quarterly to share opportunities identified to enhance patient outcomes

  • Assists in the review and revision processes of current clinical care pathways while providing insight and input on future pathway development. Escalates concerns to Facility Chief Medical Officer, as appropriate

  • Serves as a member of the Medical Staff Committees and other clinical and/or finance related groups as determined by the Chief Medical Officer in order to build trusting relationships and share observations and provider improvement opportunities

  • Collaborates with Medical Director(s) to review and provide insight regarding medical guidelines and policies

  • Assists in other duties related to utilization management, clinical documentation and quality improvement of the network as assigned by the Chief Medical Officer

  • Supports compliance with all State and Federal regulation

Qualifications

The expertise and experiences you’ll need to succeed:

2/28/22

KNOWLEDGE AND SKILLS REQUIRED:

· Strong organization skills with attention to detail

· Excellent analytical and problem-solving skills

· Effective oral and written communication skills, with the ability to articulate complex information in understandable terms to all levels of staff

· Ability to work in a matrix-management environment to achieve organizational goals

· Ability to translate ethical and legal requirements into practical and sustainable policies, balancing the needs of the business and the interest of patients and member physicians alike

· Demonstrated ability to provide expert medical advice

· Practicing Physician with Direct patient care experience of over 10 years

· Demonstrated ability to build and sustain relationships in the medical community and a corporate environment

· Payor experience in operations

KNOWLEDGE AND SKILLS PREFERRED:

· Direct involvement with supporting the development of a Utilization Management and Care Management departments

· Board Certified by ABQAURP

· Knowledge of change management principles, methodologies, and tools

EDUCATION AND EXPERIENCE REQUIRED:

· Graduate of accredited Medical School

· Bachelor of Science

· Minimum of 5 years of experience in medicine in acute care setting

EDUCATION AND EXPERIENCE PREFERRED:

· Master’s degree in Business or Healthcare Administration

· Two (2) years or greater experience as a Physician Advisor

· Prior experience with third party payors preferred

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

· Current and valid license as a physician

· Board certified in their field of practice

LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:

· Healthcare Quality and Management Certification (HQCM)

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category: Physician Services

Organization: AH Great Lakes Region

Schedule: 1 - Day

Shift: GLR Region Support

Req ID: 22027718

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.