Physician - Physician Advisor Utilization Management - Corporate

Physician Advisor

Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region.

Position Overview

The Physician Advisor collaborates with the Utilization and Care Management Departments, Organization Leadership as well as with staff physicians to ensure compliance with the organizational Utilization Management Plan.

Essential Functions

Develop and cultivate positive and productive working relationships with other Corewell Health personnel, and promote a culture of safety, teamwork, compassion, collaboration, clarity, curiosity, and courage.

Demonstrate a commitment to service and distinctive, personalized care with both internal customers (coworkers, fellow employees, hospital staff, etc.) and external customers (patients, family members, referring physicians/specialists, etc.), while striving to exceed customer expectations.

Assist in meeting operational, financial, and patient satisfaction goals.

Timely completion of all specific competencies and annual organizational mandatories.

The Physician Advisor will collaborate with the Utilization and Care Management Departments as well as physicians to provide the following functions:

• Improved accuracy of determining patient status upon hospital entry.
• Improved management of observation patients including reviews for consideration of early discharge or change to inpatient status.
• Improved timeliness of case reviews not meeting utilization management screening for inpatient criteria.
• Improved management of concurrent utilization management denials.

In addition, the Physician Advisor will collaborate to provide these additional functions:

• Acting as consultant and resource to the medical staff regarding federal and state utilization and quality regulations relative to appropriateness of hospitalization, continued stay, and use of resources
• Providing feedback to attending and consulting physicians regarding level of care, length of stay, and quality issues.
• Seeking additional clinical information from the attending and consulting physicians.
• Recommending and requesting more complete medical record documentation.
• Participating in review of long stay patients, in conjunction with the Care Management Leadership, Care Management Team and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care.
• Acting as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate.
• Providing education to physicians and other clinicians related to regulatory requirements, appropriate utilization, and alternative levels of care.

Participate in on-call and weekend coverage, as required by the Department.

Document in the patient's medical record in a manner consistent with hospital, payor, and regulatory standards.

Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis.

Qualifications

• Doctorate. Required
• License -Physician (MD) - State of Michigan Upon Hire required Or
• License -Osteopathic Physician (DO) - State of Michigan Upon Hire required
• CRT-DEA Registration - State of Michigan. Preferred
• CRT Physician Advisor Certification- American College of Physician Advisors within one-year Preferred OR
• CRT Physician Advisor Sub-Specialty certification (CHCQM-PHYADV)- American Board of Quality Assurance and Utilization Review Physicians within one-year Preferred OR
• CRT ACMA Physician Advisor Certification- American Case Management Association/Association for Physician Leadership in Care Management (APLCM) within one-year Preferred

About Corewell Health

Our new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value. Through compassion, collaboration, clarity, curiosity, and courage, we make anything and everything possible. Through our people, we care for the whole person with respect, dignity, and love. Everyone deserves opportunities and resources for better health. Everyone deserves our relentless pursuit to innovate and always do better. Everyone deserves to have a community be a great place to live, work, learn and play. We believe health and well-being should be within reach for all. We believe the system to support the entire health and wellness journey starts with prevention. We believe that together we will make a difference. Together, we are here to make health better for everyone. Together, we are Corewell Health.