Physician Advisor

At CHI Health Creighton University Medical Center - Bergan Mercy, our focus is patient-centered care. Our level I trauma center and academic medical center campus is designed to heal the body, mind, and spirit of every person in a more comfortable, less stressful hospital environment. Our full range of medical services includes trauma services, heart and vascular care, emergency services, surgery, maternity, cancer care, and diagnostic imaging.

The On-site Physician Advisor (PA) will serve as a physician leader and advocate for the improvement of a hospital’s utilization management, regulatory compliance, quality assurance, revenue integrity, and risk management. The on-site PA will work in conjunction with the Care Coordination team to address areas of high importance and/or concern in the appropriate, effective, and efficient movement of a patient through their hospital encounter (e.g.  accurate level of care determination, extended length of stay, appropriate discharge planning). As a respected member of the Medical Staff, the on-site PA will participate in, if not Chair, the UM Committee, in addition to other key hospital committees (e.g. CDI, QA). They will also serve as a resource for, and consultant to, UM staff and attending physicians regarding decisions relative to appropriateness of hospitalization and level of care, clinical documentation, extended stays, avoidable days, readmissions, and use of healthcare resources. The PA will be a resource for the UM and Medical Staff regarding federal and state utilization and quality regulations, as well as, help to facilitate training and education sessions.

• Provide leadership and oversight of facility-based physician advisory services.  

• Understand the intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, APR-DRG, and the Medicare Inpatient Prospective Payment System (IPPS) to make medical determinations based on severity of illness, acuity, and risk of morbidity/mortality.       

• Review clinical record for medical necessity of acute hospital-based care on admission (as needed-e.g. condition code 44), as well as, throughout the hospital encounter; identifying appropriate opportunities for discharge planning and quality improvement.

• Communicate, as appropriate, medical necessity assessments with treating physicians in cooperation with the utilization team and health information personnel.

• Collaborate with Care Coordination to assist in management of extended LOS encounters, specialty cases, and high-risk cases, in addition to serving as a resource for process improvement.

• Maintain UM committee membership and support  

• Champion/advocate and support CDI, regulatory compliance, and improved utilization of hospital resources.

• Support Revenue Integrity through assistance with Denial Prevention, Denial Management (e.g. Peer to Peer Review with payors when appropriate) and Regulatory Compliance.

Champion, collaborate and support Quality Assurance, and Risk Management in the facility .  
• Provide routine education and guidance to UM, Medical Staff and residents on regulatory, quality, and/or cost of care opportunities thereby supporting value based care initiatives.

• Bridge communication between Care Coordination team and Medical Staff

• Track, trend, and analyze -decided upon-performance and process improvement metrics for facility, UM/Medical Staff, and Physician Advisor program.

• Communicate facility feedback and metrics to Executive leadership (i.e. CMO, Care Management Directors, Quality Directors etc.)

• Serve as a liaison between the National Care Coordination and Physician Advisor teams with the facility-based Care Coordination teams, Medical Staff, and Executive Leaders.

Required: 

• Graduate of an accredited medical school
• MD or DO licensure within state of employment
• Board Eliglbe in the area of clinical practice

Preferred:

• Board Certification in area of clinical practice (ABMS) 
• Minimum of  five years of clinical practice experience.
• Three years of experience as a Physician Advisor and/or other  leadership experience in acute care settings with focus on utilization management and quality assurance and improvement.