Physician Advisor

Job Summary The On-site Physician Advisor (PA) will serve as a physician leader and advocate for improvement of a hospital’s utilization management, regulatory compliance, quality assurance, revenue integrity, and risk management. The PA will work in conjunction with the Care Coordination team to address high-importance areas in the patient flow, such as accurate level of care determination, extended length of stay, and appropriate discharge planning. As a respected member of the Medical Staff, the PA will participate in, or chair, the UM Committee and other key hospital committees (e.g., CDI, QA). The PA will provide resource and consultancy to UM staff and attending physicians regarding appropriateness of hospitalization, level of care, documentation, extended stays, avoidable days, readmissions, and use of healthcare resources. The PA will also serve as a resource for federal and state utilization and quality regulations and facilitate training and education sessions. Key Responsibilities Provide leadership and oversight of facility‑based physician advisory services. Understand ICD coding systems to make medical determinations based on severity, acuity, and risk. Review clinical records for medical necessity on admission and throughout the encounter; identify discharge planning and quality improvement opportunities. Communicate medical necessity assessments with treating physicians, the utilization team, and health information personnel. Collaborate with Care Coordination to assist in management of extended LOS, specialty, and high‑risk cases; serve as a resource for process improvement. Maintain UM committee membership and support. Champion and support Clinical Documentation Improvement, regulatory compliance, and improved utilization of hospital resources. Support Revenue Integrity through denial prevention, denial management, and regulatory compliance. Champion, collaborate, and support Quality Assurance and Risk Management in the facility. Provide routine education and guidance to UM, Medical Staff, and residents on regulatory, quality, and cost‑of‑care opportunities supporting value‑based care initiatives. Bridge communication between Care Coordination and Medical Staff. Track, trend, and analyze performance metrics for the facility, UM, Medical Staff, and Physician Advisor program. Communicate facility feedback and metrics to Executive leadership. Serve as a liaison between National Care Coordination and Physician Advisor teams with facility‑based Care Coordination teams, Medical Staff, and Executive Leaders. Qualifications Required qualifications: Graduate of an accredited medical school MD or DO licensure within the state of employment Board eligible in the area of clinical practice Preferred qualifications: Board certification in the area of clinical practice (ABMS) Minimum of five years of clinical practice experience Three years of experience as a Physician Advisor or other leadership experience in acute care settings focused on utilization management and quality improvement Location CHI Health Creighton University Medical Center – Bergan Mercy Pay Range $140.00 - $150.00/hour #J-18808-Ljbffr