Physician Advisor
4 weeks ago
The Utilization Management Physician Advisor is a key role within MLK Community Healthcare, responsible for ensuring the efficient and effective use of healthcare resources. This position requires a physician with a broad base of clinical experience to act as a liaison between hospital administration, clinical staff, and support personnel.
The ideal candidate will have a strong understanding of clinical utilization and care management, with experience in identifying best practices and analyzing data to inform decision-making. This role will involve collaborating with care management staff, physicians, and other healthcare professionals to discuss selected cases and make recommendations for care.
The Utilization Management Physician Advisor will also serve as a consultant to attending physicians, providing guidance on the appropriateness of hospitalization, continued stay, and use of resources. This role requires strong communication and interpersonal skills, as well as the ability to work independently and manage multiple tasks and projects.
Key Responsibilities- Conduct clinical reviews on cases referred by care management staff and/or other healthcare professionals to meet regulatory requirements and ensure quality patient care.
- Collaborate with care management staff to advance quality, safety, and financial targets.
- Assist care management staff with patient transfer needs to alternative levels of care when required.
- Exhibit excellent and timely follow-up of communication amongst patients, families, care managers, physicians, and payors.
- Use information from the current utilization management software program as needed for decision-making related to patient admission or observation status.
- Collaborate with care management for cases that do not meet the current utilization management software program for admission criteria and document discussions with physicians as needed.
- Facilitate peer-to-peer discussion and clinical documentation opportunities.
- Assist when necessary in mediation amongst different departments, teams, or individuals involved with the patient's episode of care.
- Assist medical and professional staff with education regarding DRG LOS, denials, clinical documentation, practice guidelines within the EMR, and any regulatory changes.
- Maintain current physician advisor knowledge of regulatory and practice changes.
- Completed MD or DO accredited residency program.
- Four (4) years in the healthcare setting and in a managed care environment with Hospitalist experience preferred.
- Minimum of five (5) years of clinical practice experience following the completion of residency or fellowship training.
- Experience identifying best practices, clinical utilization, and care management preferred.
- Active and unrestricted License to practice medicine in the State of California.
- Board certified in a specialty approved by the American Board of Medical Specialties (ABMS).
- Ability to prioritize and resolve critical issues efficiently and effectively.
- Strong quantitative, analytical, and technical skills relating to data management, analysis, and presentation.
- Strong PC/Microsoft application skills, including Word, Advanced Excel, and PowerPoint.
- Strong oral and written communication skills.
- Ability to deliver presentations to a wide variety of audiences.
- Ability to effectively plan and facilitate meetings and workgroups.
- Excellent organizational skills and attention to detail, ability to work independently, manage multiple tasks and projects, meet deadlines, and manage to schedule.
- High degree of initiative along with ability to act as a team player.
- Ability to develop effective relationships with a broad array of people (different levels of management and clinical experts).
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Physician Advisor
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