Facility: Kennestone Hospital

Job Summary:

The Physician Advisor reports to and is accountable to the Chief Medical Officer 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 CMOs in the WellStar Health System (WHS), the Physician Advisor (PA) will be involved in the following areas:

Utilization Management: The Physician Advisor (PA) 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 for appropriateness of care; proper level of care in accordance with hospital objectives for assuring quality patient care and effective, efficient utilization of health care services, and to meet regulatory requirements. Working as a peer to physicians and as a consultant to Care Management and administration, the PA intervenes when practice patterns or behaviors or documentation issues create disparity between pathway standards, intensity of service, severity of illness, patient and family rights, teamwork, or other issues regarding the stewardship of resources for individual patients, diagnostic populations, and the organization as a whole. In the area of Readmissions, the Physician Advisor will help to lead the effort to reduce avoidable readmissions. The Physician Advisor will engage with Physicians, Advanced Practice Professionals, nursing and other ancillary personnel as well as administrative leaders as part of his/her role in Performance Improvement, Resource Utilization and ongoing education on imp8ortant trends in healthcare management.

Quality Improvement: In addition to the above duties, the PA will work with the CMO and the Quality Director or Manager at the hospital on quality improvement initiatives to assist the hospital to achieve its annual goals.

The Physician Advisor (PA) will work closely with the Care Coordination/Care Management team to provide timely consultation and clinical expertise to ensure fiscally responsible and efficient utilization of resources. These duties will include but not be limited to areas such as concurrent assessment of the clinical situation, determination of medical necessity and appropriate level of care, real time feedback to physicians and case managers and all necessary follow-up with appropriate and clear communications of next actions to physicians; care coordinators, social workers, nursing staff and other key people involved in caring for individual patients whose cases have been referred for consultation.

Required Minimum Education:

• Doctorate Medicine or Doctorate Osteopathic Medicine
• Masters Business Administration/Management or Masters Health Administration is preferred

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

• Doctor of Osteopathic Medicine or Medical Doctor

Additional License(s) and Certification(s):

• Board certified in specialty of practice is preferred.
• Health Care Quality & Management Certification, (i.e. ABQAURP or equivalent) is preferred.

Required Minimum Experience:

• Minimum 8 years of years clinical experience is required.
• Minimum 1 year of experience post residency of Utilization Management experience with a 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.