Overview

The UChicago Medicine | AdventHealth Physician Advisor provides primary care support for Care Management (CM) and secondary support for Clinical Documentation Integrity (CDI) and Quality departments and services as a liaison between UM and CM teams and medical staff, as well as the medical liaison for payor escalations. The Physician Advisor is responsible for educating, informing and advising members of the Utilization Management, Care Management, Clinical Documentation, Managed Care and Revenue Cycle departments and applicable medical staff, as well as, collaborating with other disciplines to assist in the improvement of clinical documentation, patient safety, and quality outcomes.

Responsibilities

Though support of Utilization Management, the Physician Advisor is responsible for providing clinical review of utilization, claims management, and quality assurance related to inpatient care, outpatient care/observation stays and referral services. The Physician Advisor is an important contact for clinicians, external providers, contracted health insurance payors, and regulatory agencies. This individual also serves as the subject matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient focused and cost effective medical care.

PRINICPAL DUTIES AND JOB RESPONSIBILITIES:

• Provides clinical support/validation for Care Managment, CDI and Quality teams
• Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care Management structures, and functions and use of clinical guidelines
• Develops and facilitates productive internal/external relationships with all physicians and constituents of Utilization Management, Care Management and CDI departments

KNOWLEDGE AND SKILLS REQUIRED:

• Strong organization skills with attention to detail
• Excellent analytical and problem solving skills
• Effective oral and written communication skills, with the ability to articulate compile information in understandable terms to all levels of staff
• Ability to work in a matrix-management environment to achieve organizational goals
• Ability to translate ethical and legal requirements into practical and sustainable policies, balancing the needs of the business and the interest of patients and member physicians alike
• Demonstrated ability to provide expert medical advice
• Practicing Physician with Direct patient care experience of over 10 years
• Demonstrated ability to build and sustain relationships in the medical community and a corporate environment
• Payor experience in operations

KNOWLEDGE AND SKILLS PREFERRED:

• Direct involvement with supporting the development of a Utilization Management and Care Management departments
• Board Certified by ABQAURP
• Knowledge of change management principles, methodologies, and tools
• Prior experience with third party payors 
• Healthcare Quality and Managment Certification (HQCM)

Qualifications

EDUCATION, EXPERIENCE AND LICENSURE REQUIRED:

• Graduate of accredited Medical School
• Current and valid license as a physician
• Board Certified in specialty area