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Physician Advisor

Traverse City, MI

Website:
https://nlx.jobsyn.org/6ca6df5a6c354646b98f0fd67117e641151

Posted on July 19, 2018

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About Physician Advisor

GENERAL SUMMARY

Serves as a Physician Advisor for Case Management for Munson Healthcare Cadillac Hospital; Munson Healthcare Grayling Hospital; and Munson Medical Center.

Functions as a representative of the physician leadership and the hospital. Serves as a resource to the Care Management staff to promote evidence based practice, appropriate resource utilization, and compliance with all local and system policies, state, accrediting and federal regulations governing medical necessity, continuing care, and discharge planning. Conducts clinical review on cases referred by Patient Care Management (PCM) staff, administration, physician leadership and/or other health care professionals in accordance with hospital objectives for assuring safe quality patient care and effective, efficient utilization of health care services, and to meet regulatory requirements. Functions as a peer to physicians and a consultant to PCM and administration. Intervenes when practice or behaviors create disparity between pathways and protocol standards, intensity of service, severity of illness, patient and family rights, collaborative teamwork, or other issues regarding the stewardship of resources for individual patients, diagnostic populations, and the organization as a whole. This position is accountable to the Chief Medical Officers at Munson Medical Center and Munson Healthcare.

ENTRY REQUIREMENTS

  • Graduate of an accredited medical school and licensed in the state of Michigan

  • Additional education in quality and utilization management through continuing medical education programs and/or self-study required. Utilization management experience as a member of an oversight committee or past physician advisor experience preferred.

  • Minimum of 5-10 years of recent experience in clinical practice

This is full-time salaried position however, will consider filling the position at 30 hours/week in order to maintain a clinical practice

ORGANIZATION

Reports to the MMC Chief Medical Officer and to the MHC Chief Medical Officer.

Works in collaboration with the Service Line Directors and the CMOs, Health Information Management and Patient Care Management teams at the MHC entities.

ABOUT MUNSON MEDICAL CENTER

Munson Medical Center, a 442-bed regional referral center located in Traverse City, Mich., is in the midst of exciting development and is well positioned for continued growth and success. As a part of the nine-hospital Munson Healthcare system, our medical staff of more than 420 physicians representing 50+ specialty services and 3,700 employees are dedicated to providing exceptional healthcare to 540,000 people in northern Michigan – a spectacular, four-season recreational region on the freshwater shoreline of Lake Michigan.

We serve as a regional referral hospital for 24 counties in northern Michigan and have:

  • The only Level II Trauma Center north of Grand Rapids

  • The only Neonatal Intensive Care Unit in northern Michigan

  • One of two open heart surgery programs in northern Michigan

We are proud to have been named a 100 Top Hospital 14 times by Thomson Reuters, one of only three in the nation recognized so often for superior quality and operational performance. We have also been repeatedly named a 100 Top Cardiovascular Hospital because of our outstanding heart program and are among only 5 percent of hospitals awarded Magnet Recognition by the American Nurses Credentialing Center for nursing excellence.

AGE OF PATIENTS SERVED

No direct clinical contact with patients

PRINCIPLE DUTIES & RESPONSIBILITIES

  1. Provides timely, clinically and fiscally effective consultation to PCM, including concurrent assessment of the clinical situation, determination of next actions, the actions themselves, and all necessary follow-up, expediting communications of next actions to Utilization Review Specialists, Social Workers, physicians, and other key people involved in caring for individual patients whose cases have been referred for consultation

  2. Assists with level of care and length of stay management

  3. Assists with denial management

  4. Reviews and makes suggestions regarding resource and service management

  5. Assists staff with clinical review of patients and refer cases to peer review when appropriate

  6. Provides education in real time for concerns about patient status

  7. Provides education regarding insurance rules and regulations

  8. Determine if professionally recognized standards of quality care are met

  9. Collaborates with other team members

  10. Develops and operationalizes policies, systems and processes to support the case management function for Munson Healthcare entities

  11. Participates with Case Management leadership, Utilization Review Committees and coordinates its activities with other key committees

  12. Meets routinely with Chief Medical Officers and others to review/revise objective and subjective targets in cost, quality, and satisfaction. Have working knowledge and understanding of PCM Dashboard and physician profiles

  13. Supports planned, sequenced ongoing education about payer and utilization matters, best clinical practice data and research, health care trends, processes collaborative initiatives and skills, post-acute continuum capabilities, changes in hospital policies and operations, and other salient subjects to physicians (on staff and private practice), physician assistants and nurse practitioners, medical students, and others

  14. Functions as a consultant to the PCM program to ensure adequate structure within the departments to allow efficient and effective delivery of service

  15. Responds in a timely manner to requests to intervene with payers, denials and appeals processes, observation level of care, decisions regarding admission and the transition of patients through levels of care, end-of-life dilemmas, issuance of HINNS or other termination of benefits notification, and other situations as requested or as discovered

  16. Serves as an expert resource to physicians and others regarding immediate or planned decisions when overt quality, safety, ethical, regulatory, and/or financial risks may be incurred

  17. Reviews extended length of stay and high dollar accounts at least weekly and on an as-needed basis

  18. Brings matters of potential or actual problems in physician practices to the attention of the CMOs

  19. As requested, serves as an expert clinical resource on development and utilization of established clinical guidelines, protocols, standard work, order sets, pathways, and other structured care methodologies

  20. Participates as a member of the daily unit rounds on nursing units at Munson Medical Center and other entities as appropriate

  21. Uses a panel of physician experts in areas outside own expertise to bring specialty knowledge to bear on complex clinical resource situations, including Infectious Disease, Psychiatry, Radiology, etc. Proactively integrates principles of continuous quality improvement to raise the standard of physician practice and ultimately the practice of the hospital

  22. As requested, participates in the identification of opportunities for the organization to increase market share, flow and capacity, disease management support of populations, obtain grants, etc.

  23. Documents according to policy

  24. Performs all other duties as assigned

Job at a Glance

About Munson Medical Center

How to Apply