Wellstar Health System
Executive Director, Physician Advisor
Wellstar Health System, Marietta, Georgia, United States, 30064
Executive Director, Physician Advisor – Wellstar Health System
Overview
The Physician Advisor reports to and is accountable to the Vice President Medical Affairs (VPMA) to impact quality, utilization, patient satisfaction and efficiency metrics through Performance Improvement and education initiatives that will enable the facility to achieve its stated goals. Working in collaboration with the VPMA(s) in the WellStar Health System (WHS), the Physician Advisor (PA) will be involved in the following areas: Responsibilities
Utilization Management: The Physician Advisor will conduct clinical review on cases for commercial payers and Medicare Advantage plans that are referred by Care Coordination/Case Management staff and/or other health care professionals to assess appropriateness of care; determine proper level of care in accordance with hospital objectives to assure quality patient care and efficient utilization of services, and to meet regulatory requirements. The PA will intervene when practice patterns or documentation issues create disparities between pathway standards, intensity of service, severity of illness, patient and family rights, teamwork, or other issues regarding resource stewardship for individual patients, diagnostic populations, and the organization as a whole. In the area of Readmissions, the PA will help lead efforts to reduce avoidable readmissions. Quality Improvement: In collaboration with the VPMA and the Quality Director/Manager, the PA will participate in quality improvement initiatives to help the hospital achieve its annual goals. Core Responsibilities and Essential Functions
The PA works closely with the Care Coordination/Care Management team to provide timely consultation and clinical expertise to ensure fiscally responsible and efficient utilization of resources. Duties include concurrent assessment, determination of medical necessity and appropriate level of care, real-time feedback to physicians and case managers, and clear communication of next actions to physicians, care coordinators, social workers, nursing staff and other involved personnel. Assist with level of care and length of stay management, including assessment of Inpatient vs. Outpatient Observation status, compliance with regulatory rules, throughput initiatives and care transition issues. Lead readmission reduction initiatives at the facility in collaboration with the VPMA and the Readmission PIC Chairperson. Assist with denial management on a concurrent basis when possible. Collaborate with Care Coordination Leadership to expedite case management issues and manage work queues. Review and suggest improvements in resource and service management; review clinical records for appropriate documentation to substantiate medical necessity and level of care; work with Clinical Documentation Excellence Specialists to resolve physician documentation queries. Work with Hospital-based Medical Director(s) to address throughput, length of stay, excess days and other barriers to the continuum of care to improve efficiency. May participate in development and planning of care for specialized patient populations or those requiring Complex Disease & Care management; plan and develop programs to facilitate management of patient populations through the continuum of care. Determine if professionally recognized standards of quality care are met by coordinating with the Quality Department and referring to Peer Review when necessary. Assist in reviewing regulatory reports (e.g., RAC audits, QIO reports) to identify trends and develop action plans for improvement. Participate in a limited on-call schedule with colleagues as determined by the team; be available by phone/electronic means for chart reviews and on-site support as needed for WellStar facilities. Support ongoing education about payer and utilization matters, best clinical practice data, healthcare trends, collaborative initiatives, changes in hospital policies and operations. Serve as a consultant to Care Management to ensure adequate structure for efficient delivery of services. Respond to requests to intervene with payers, denials and appeals, observation decisions, admission and transition of patients through levels of care, end-of-life decisions, and other situations as requested. Act as an expert resource to physicians and hospital administration regarding quality, ethical, regulatory, and financial risks; lead or co-lead Hospital-wide Complex Care Rounds on a regular basis. Bring matters of potential or actual problems in physician practices to the attention of the VPMA; serve as an expert clinical resource on development and utilization of established clinical guidelines, order sets, pathways, and other structured care methodologies. Use a panel of physician experts in areas outside own expertise to inform complex clinical resource decisions (e.g., Infectious Disease, Psychiatry, Radiology). Required Minimum Education
Doctorate of Medicine or Doctorate of Osteopathic Medicine is required. Masters preferred. Required Minimum License(s) And Certification(s)
All certifications are required upon hire unless otherwise stated. DO - Doctor of Osteopathic Medicine or MD - Medical Doctor required. Additional License(s) And Certification(s)
Board certified in the specialty of practice is preferred. Health Care Quality & Management Certification (e.g., ABQAURP or equivalent) is preferred. Required Minimum Experience
Minimum 8 years clinical experience is required. Minimum 1 year of Utilization Management experience post residency with focus on clinical documentation, medical necessity assessment, billing and coding acumen, business, strategic planning, financial planning and development is required. Required Minimum Skills
Communicate and understand verbal and written English language Display a positive attitude Organizational skills that enable the individual to react and perform under stress and emergency situations Manage two to three activities at one time on an ongoing basis Management skills to effectively lead physicians Must display the character and disposition to foster physician engagement Time management skills to meet scheduled and non-scheduled operational deadlines Analytical skills to prepare and manage budget Job Details
Seniority level: Executive Employment type: Full-time Industries: Hospitals and Health Care
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Overview
The Physician Advisor reports to and is accountable to the Vice President Medical Affairs (VPMA) to impact quality, utilization, patient satisfaction and efficiency metrics through Performance Improvement and education initiatives that will enable the facility to achieve its stated goals. Working in collaboration with the VPMA(s) in the WellStar Health System (WHS), the Physician Advisor (PA) will be involved in the following areas: Responsibilities
Utilization Management: The Physician Advisor will conduct clinical review on cases for commercial payers and Medicare Advantage plans that are referred by Care Coordination/Case Management staff and/or other health care professionals to assess appropriateness of care; determine proper level of care in accordance with hospital objectives to assure quality patient care and efficient utilization of services, and to meet regulatory requirements. The PA will intervene when practice patterns or documentation issues create disparities between pathway standards, intensity of service, severity of illness, patient and family rights, teamwork, or other issues regarding resource stewardship for individual patients, diagnostic populations, and the organization as a whole. In the area of Readmissions, the PA will help lead efforts to reduce avoidable readmissions. Quality Improvement: In collaboration with the VPMA and the Quality Director/Manager, the PA will participate in quality improvement initiatives to help the hospital achieve its annual goals. Core Responsibilities and Essential Functions
The PA works closely with the Care Coordination/Care Management team to provide timely consultation and clinical expertise to ensure fiscally responsible and efficient utilization of resources. Duties include concurrent assessment, determination of medical necessity and appropriate level of care, real-time feedback to physicians and case managers, and clear communication of next actions to physicians, care coordinators, social workers, nursing staff and other involved personnel. Assist with level of care and length of stay management, including assessment of Inpatient vs. Outpatient Observation status, compliance with regulatory rules, throughput initiatives and care transition issues. Lead readmission reduction initiatives at the facility in collaboration with the VPMA and the Readmission PIC Chairperson. Assist with denial management on a concurrent basis when possible. Collaborate with Care Coordination Leadership to expedite case management issues and manage work queues. Review and suggest improvements in resource and service management; review clinical records for appropriate documentation to substantiate medical necessity and level of care; work with Clinical Documentation Excellence Specialists to resolve physician documentation queries. Work with Hospital-based Medical Director(s) to address throughput, length of stay, excess days and other barriers to the continuum of care to improve efficiency. May participate in development and planning of care for specialized patient populations or those requiring Complex Disease & Care management; plan and develop programs to facilitate management of patient populations through the continuum of care. Determine if professionally recognized standards of quality care are met by coordinating with the Quality Department and referring to Peer Review when necessary. Assist in reviewing regulatory reports (e.g., RAC audits, QIO reports) to identify trends and develop action plans for improvement. Participate in a limited on-call schedule with colleagues as determined by the team; be available by phone/electronic means for chart reviews and on-site support as needed for WellStar facilities. Support ongoing education about payer and utilization matters, best clinical practice data, healthcare trends, collaborative initiatives, changes in hospital policies and operations. Serve as a consultant to Care Management to ensure adequate structure for efficient delivery of services. Respond to requests to intervene with payers, denials and appeals, observation decisions, admission and transition of patients through levels of care, end-of-life decisions, and other situations as requested. Act as an expert resource to physicians and hospital administration regarding quality, ethical, regulatory, and financial risks; lead or co-lead Hospital-wide Complex Care Rounds on a regular basis. Bring matters of potential or actual problems in physician practices to the attention of the VPMA; serve as an expert clinical resource on development and utilization of established clinical guidelines, order sets, pathways, and other structured care methodologies. Use a panel of physician experts in areas outside own expertise to inform complex clinical resource decisions (e.g., Infectious Disease, Psychiatry, Radiology). Required Minimum Education
Doctorate of Medicine or Doctorate of Osteopathic Medicine is required. Masters preferred. Required Minimum License(s) And Certification(s)
All certifications are required upon hire unless otherwise stated. DO - Doctor of Osteopathic Medicine or MD - Medical Doctor required. Additional License(s) And Certification(s)
Board certified in the specialty of practice is preferred. Health Care Quality & Management Certification (e.g., ABQAURP or equivalent) is preferred. Required Minimum Experience
Minimum 8 years clinical experience is required. Minimum 1 year of Utilization Management experience post residency with focus on clinical documentation, medical necessity assessment, billing and coding acumen, business, strategic planning, financial planning and development is required. Required Minimum Skills
Communicate and understand verbal and written English language Display a positive attitude Organizational skills that enable the individual to react and perform under stress and emergency situations Manage two to three activities at one time on an ongoing basis Management skills to effectively lead physicians Must display the character and disposition to foster physician engagement Time management skills to meet scheduled and non-scheduled operational deadlines Analytical skills to prepare and manage budget Job Details
Seniority level: Executive Employment type: Full-time Industries: Hospitals and Health Care
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