Physician - Physician Advisor Utilization Management - Corporate

ThePhysician Advisorcollaborates 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 Corewell Health personnel, and promote a culture of safety, teamwork, compassion, collaboration, clarity, curiosity, and courage. 

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

Assist in 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 of determining patient status upon hospital entry.  

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

• Improved timeliness of case reviews not meeting utilization management screening for inpatient criteria.  

• Improved management of concurrent utilization management denials.  

In addition, the Physician Advisor will collaborate to provide these additional functions:  

• 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 physicians regarding level of care, length of stay, and quality issues.  

• Seeking additional clinical information from the attending and consulting physicians.  

• Recommending and requesting more complete medical record documentation.  

• Participating in review of long stay patients, in conjunction with the Care Management Leadership, Care Management Team and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care.  

• Acting as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate.  

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

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

Document in the patient’s medical record in a manner consistent with hospital, payor, and regulatory standards.  

Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis.