Physician Physician Advisor Utilization Management Corporate

The Physician Advisor collaborates with the Utilization and Care Management Departments Organization Leadership as well as with staff physicians to ensure compliance with the organizational Utilization Management Plan.

Develop and cultivate positive and productive working relationships with other CorewellHealth personnel and promote a culture of safety teamwork compassion collaboration clarity curiosity and courage.

Demonstrate a commitment to service and distinctive personalizedcare withboth internal customers (coworkers fellow employees hospital staff etc.) and external customers (patients family members referring physicians/specialists etc.) while striving to exceed customer expectations.

Assistin meeting operational financial and patient satisfaction goals.

Timely completion of all specific competencies and annual organizational mandatories.

The Physician Advisor will collaborate with the Utilization and Care Management Departments as well as physicians to provide the following functions:

• Improved accuracy ofdeterminingpatient status upon hospital entry.

• Improved management of observation patientsincluding reviews for consideration of early discharge or change to inpatient status.

• Improved timeliness of case reviews not meetingutilizationmanagement screening for inpatient criteria.

• Improved management of concurrentutilizationmanagement denials.

In addition the Physician Advisor will collaborate to provide theseadditionalfunctions:

• Acting as consultant and resource to the medical staff regarding federal and state utilization and quality regulations relative to appropriateness of hospitalization continued stay and use of resources

• Providing feedback to attending and consulting physiciansregardinglevel of care length of stay and quality issues.

• Seekingadditionalclinical information from the attending and consulting physicians.

• Recommending and requesting morecompletemedical record documentation.

• Participating in review oflong staypatients in conjunction with the Care Management Leadership Care Management Team and other members of the multidisciplinary team tofacilitatethe use of the mostappropriate levelof care.

• Acting as a liaison with payers tofacilitateapprovals and prevent denials or carved out days whenappropriate.

• Providing education to physicians and other clinicians related to regulatory requirementsappropriate utilization and alternative levels of care.

Participate in on-call and weekend coverage as required by the Department.

Document in the patients medical record in a manner consistent with hospital payor and regulatory standards.

Activelyparticipatesin safety initiatives and risk mitigating measures whereappropriateand completes all position and unit safety related competencies and requirements ona timelybasis.