Internal Medicine Hospital Based job located in Alabama

• Utilization Review
• Length of stays
• Medical necessity

Physician Advisor

Summary

The Physician Advisor plays a crucial role in healthcare by collaborating with medical staff and leadership teams to ensure the delivery of high-quality, cost-effective patient care. This position is responsible for:

- Collaborating with the Utilization Management Committee (UMC) and supporting the Case Management (CM) and Health Information Management (HIM)/Clinical Documentation Improvement Departments.
- Promoting processes that facilitate patients receiving medically necessary and high-quality care throughout their continuum of care.
- Staying updated on professional best practices and community standards of care to contribute to informed decision-making.
- Assisting administration in mitigating financial risks associated with denials due to medically unnecessary or preventable services and prolonged length of stays.

Responsibilities

- Collaborate with the Utilization Management Committee (UMC) to review and analyze utilization patterns, identify improvement opportunities, and implement strategies for optimal resource utilization while maintaining quality care.
- Provide guidance and support to the Case Management (CM) and Health Information Management (HIM)/Clinical Documentation Improvement Departments to ensure accurate documentation of patient care and outcomes.
- Develop and implement protocols for appropriate utilization of healthcare services, including prior authorizations, length of stay management, and discharge planning.
- Serve as a resource and consultant to healthcare providers, offering expertise on evidence-based practices, clinical guidelines, and regulatory requirements.
- Participate in peer-to-peer discussions with payers to advocate for medically necessary services and resolve utilization review issues.
- Collaborate with administration to develop strategies addressing denials and appeals related to medical necessity and length of stay.
- Monitor healthcare trends and regulatory changes to ensure compliance and continuous improvement in patient care delivery.

Qualifications

- Doctor of Medicine Degree (M.D.) or Doctor of Osteopathic Medicine Degree (D.O.) from an accredited medical school.
- Preferably holds an advanced degree in Business and/or Health Care Administration to demonstrate understanding of healthcare management principles.
- Minimum 2 years of experience in a physician role, preferably with exposure to Utilization Management and hospital committee participation.
- Ability to work collaboratively with medical staff, healthcare providers, and administrative teams to achieve common goals.
- Strong analytical, communication, and problem-solving skills with focus on improving healthcare outcomes and reducing financial risks.

Conclusion

The Physician Advisor role is pivotal in ensuring efficient healthcare delivery through collaboration with medical staff and leadership teams. The ideal candidate will possess strong medical expertise, collaboration skills, and a commitment to enhancing patient care quality and financial performance.