Job Summary / Purpose

The Physician Advisor is a key member of Trinity Health System leadership team and is charged with meeting the organization’s 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 management and utilization review departments, medical staff members, 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, appropriate physician coding and documentation requirements.

The Physician Advisor works closely with the medical staff leadership, the entire medical staff, all areas of resource management, case management, 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. This includes working with hospital leadership in developing care management 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.

The Physician Advisor reports directly to the Chief Medical Officer

Essential Key Job Responsibilities

ACUTE INPATIENT/CASE MANAGEMENT FUNCTIONS:

• Perform medical necessity reviews including initial level of care, secondary reviews, and continued stay reviews
• Assist with length of stay management and utilization of resources
• Assist with the denial management process
• Understand and use MCG/InterQual and other appropriate criteria. Document response to case management referrals. Support Case Management in a data-driven approach
• Assist Hospital Administration and the Medical Staff in connection with any regulatory audits, investigation, survey, or other review of the Departments
• 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
• Participate 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
• Participate in Multidisciplinary Rounds (MDR) with the Healthcare Team as indicated
• Provide guidance to ED physicians and ED Case Management regarding status issues and alternatives to acute care when acute care is not warranted

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 level 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.
• Ensures physician accountability for efficient patient care management.
• Investigates avoidable delay concerns referred by case management staff that effect 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 the CMO, Care Coordination Director, or hospital leadership.

ORGANIZATIONAL PROCESS IMPROVEMENT:

• Identify quality, safety, patient satisfaction, and efficiency issues leading to sub-optimal care. Take appropriate action to resolve.
• Promote and educate healthcare team 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.
• Actively participates in achieving hospital and Care Coordination performance metrics, including length of stay, observation rate, concurrent denial reduction, and others as identified.

Minimum Qualifications

Age of Patients Served

Physical / Functional Job Requirements

Organizational Information

MISSION & VISION

The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities.

Our Vision is to live up to our name as one CHI:

Catholic – Living our Mission and Core Values;
Health – Improving the health of the people and communities we serve;
Initiatives – Pioneering models and systems of care to enhance care delivery.

LIVING THE CORE VALUES OF CHI

CHI STANDARDIZED COMPETENCIES

LEADERSHIP COMPETENCIES

Focuses on results and desired outcomes setting a climate of achievement. Holds others accountable for goal attainment.

Incorporates new methods or approaches to solving problems; cultivates alternative viewpoints; actively seeks varied perspectives when problem solving; develops a team that reflects the diversity of Catholic Health Initiatives’ clients and employees; encourages diversity and sharing new ideas.

Accurately assesses the potential barriers and resources necessary for change; challenges the status quo, and takes personal ownership for leading change that enhances the organization; inspires others to think positively about change.

Builds teamwork and participation. Works together to bring out the best in everyone. Provides useful, caring feedback for growth to team.

Sets clear performance expectations with associated celebration and rewards; builds a high performance group with a focus on excellence and achievement orientation; recognizes individual achievements throughout the performance period; ensures others know how they are performing throughout the year

Fosters professional and personal development; nurtures individual strengths and abilities to develop employee skill sets; provides feedback honestly, even when difficult

Articulates a compelling vision that promotes the goals that need to be attained and metrics for success; builds commitment to Catholic Health Initiative’s healing ministry; communicates what needs to be accomplished for the vision to be realized; relates CHI’s legacy of care

Is open and honest in all interactions; acts with moral wholeness, soundness, and truthfulness; demonstrates trust and respect for others; acts according to values and beliefs

PROTECTED HEALTH AND OTHER CONFIDENTIAL INFORMATION

This job accesses, uses and discloses patient protected health and other confidential information and will use and disclose patient protected health and other confidential information:

Job descriptions reflect the general details considered necessary to describe the essential functions of the jobs as identified, and shall not be considered a detailed description of all work requirements that may be inherent in the positions, nor shall they prescribe or restrict tasks assigned. Changes to jobs may occur at any time. Reasonable accommodations will be made.