Physician Advisor

The Physician Advisor is akey member of the healthcare organization’s leadership team and is chargedwith meeting the organization’s goals and objectives for assuring the effective,efficient utilization of health care services. The Physician Advisor is aphysician serving the hospitalthrough teaching, consulting, and advising the care management and utilizationreview departments and hospital leadership. The Physician Advisor shalldevelop expertise on matters regarding physician practice patterns, over andunder-utilization of resources, medical necessity, levels of care, careprogression, denial management, compliance with governmental and privatepayer regulations, appropriate physician coding and documentation requirements. The Physician Advisor works closely with the medical staff leadership, medical staff, including resident physician house staff, all areas of resource management, case management, social services, and utilizationmanagement to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided. Supports the Revenue (Rev) Cycle, serving as a liaison between Rev Cycle and the medical staff members across the system, communicating with physicians and other health professionalsThis includes working with hospitals for efficient management of resources, insuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities. The Physician Advisor reports directly to the: Medical Director if the Internal Physician Advisor Service (IPAS)

PRIMARY SCOPE OF SERVICE:

MINIMUM JOB SPECIFICATIONS:

Doctoral degree in Medicine (M.D or D.O.) Hold and maintain an unrestricted medical license in the state of Michigan. Board Certification. Minimum five years of clinical practice. Meet the requirements (and become a member) of the Henry Ford Medical Staff. Possessor acquires a solid foundation, knowledge, and/or experience in the areas ofutilizationmanagement, quality improvement, and patient safety. Possessa working knowledge of organization & case management operationsand administrative standards and policies. Strongcomputer skills and working knowledge of EMRs (EPIC preferred). Familiarity with MCG/InterQual placement statuscriteria is preferred. Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) or the American College of Physician Advisors (ACPA-C) preferred. Abilityto build rapport with medical staff and hospital leadership to obtain the buy-inand collaboration necessary to achieve desired outcomes

ORGANIZATION EXPECTATIONS:

Demonstratesbehavior that supports the organization’s mission. Participates in requiredorientation and training related to the Physician Advisor role Meetsproduction standards within established time requirements. Work productivity and performance meet qualitystandards. Demonstratesrespect and uses positive interpersonal skills with patients, clients, thepublic, managers, and employees at all times. Maintainsconfidentiality of patient care and business matters. Adheresto all professional and performance expectations set forth within the medical staff bylaws, rules & regulations and complies with all Henry Ford establishedpolicies and procedures. Participatein ongoing training and education related to the Physician Advisor role andresponsibilities including topics related to Utilization Management, Care Managementand other related areas as requested. Obtainsfamiliarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specificvariables as may be necessary or justifiable.

CLINICAL EFFECTIVENESS:

Demonstrates commitment to meeting/exceedingstrategic initiatives of organization. Responds to requests for assistance on clinical reviewsfor medical necessity or any other reason, by any member of the Utilization Management (UM)department in a timely fashion. Upholds the organization’s values of teamworkand professionalism and applies Code of Conduct standards to all members of thehealthcare team. Provides consultation to nurses and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management.

ACUTE INPATIENT/CASE MANAGEMENT FUNCTIONS:

Review medical records of patients identified by UM or as requested by the healthcare team to perform quality and utilization oversight Perform medical necessity reviews including initial level of care, secondary reviews, and continued stay reviews Perform Peer-to-Peer calls for inpatient and post-acute care denials Assist with length of stay management and utilization of resources Review and make suggestions related to resource and service management Provide regular feedback to physicians and all other stake holders regarding level of care, length of stay, and potential quality issues Recommend and request additional and more complete medical record documentation to support placement status or medical necessity Understand and use MCG/InterQual and other appropriate criteria. Document response to UM referrals. Support case management and physicians in the post-acute care process Assist Hospital Administration and the Medical Staff in connection with any regulatory audits, investigation, survey, or other review of the Departments Ensure consistency of utilization review services, quality control, and patient safety Act as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate by participating in Peer-to-Peer discussions and reviews Facilitate, mentor, and educate other physicians regarding payer requirements Provide guidance to ED physicians and Access Care regarding status issues and alternatives to acute care when acute care is not warranted Participate in all organizational efforts to reduce inappropriate readmissions

PHYSICIAN SUPPORT, EDUCATION, AND COLLABORATION:

Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources, and alternative levels of care. Provide education to physicians and other clinicians regarding inappropriate admissions and create action plans to address this issue. Provide physician coaching and on-going education on appropriate clinical documentation improvement and care standards as may be appropriate.

PHYSICIAN LIAISON:

Conducts physician education sessions to share data, trends, practice patterns, and other relevant information as requested. Works with hospital UM Medical Directors to: Ensures physician accountability for efficient patient care management. Investigates avoidable delay concerns referred by case management staff that affect patients' outcomes during their hospital stay. Contacts physicians in a timely manner to resolve delays and achieve positive outcomes. Demonstrates positive outcomes through interventions with attending or consulting physicians that delay care and affect the length of stay or avoidable delays, etc. Identifies denial trends and works with the medical staff and hospital administration to resolve the issue. Reports practice pattern trends and opportunities to service line or department specific meetings at the request of hospital leadership.

ORGANIZATIONAL PROCESS IMPROVEMENT:

Promote and educate healthcare teams on a team approach to patient care. Promotes coordination, communication, and collaboration among all team members. Support the organization in quality improvement efforts requiring physician input and/or involvement.

MEDICAL INFORMATICS SUPPORT:

Works with the IT Leadership team to ensure the system appropriately supports the physician's ability to provide best practice medicine by creating logical processes and providing the necessary order sets and practice guidelines. Participates in physician education and outreach efforts. Works in collaboration with the IT team to be sure all necessary physicians are trained, and training is appropriate for the physicians. Assists with order set development, review, and implementation to coordinate quality, efficiency, and utilization of the order sets, as requested. #J-18808-Ljbffr Houston Methodist Clear Lake