Lead Physician Advisor (Exempt)

• Leadership Decision Making - Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable. Drives results.
• Coaching & Building Talent - Achieves results through other leaders by empowering them and providing feedback, instruction and development (coaching the coach) to develop their own associates; plans and supports the growth of individual skills and abilities in preparation for their next role (building bench); focuses on retention of high performers.
• Delegation - Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement.
• Leading Teams - Inspires and sustains team unity and engagement by developing, motivating, and guiding the team to achieve results together through productive relationships and work.
• Executive Communication - Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others’ attention (appropriate, impactful, and clear).
• Program/Project Management - Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste and exceptional results.

• Maintains accountability for achieving utilization / resource management outcomes and fulfills the obligations and responsibilities of the role to support the medical staff in the clinical progression of patient care.
• Reviews issues identified by UR staff to ensure appropriate follow-up, recommend improvement initiatives as needed, and make referrals to the appropriate department chair as necessary.
• Responds to requests for assistance on clinical reviews for medical necessity or any other reason, by any member of the Utilization department in a timely fashion.
• Provides consultation to nurses and case management staff regarding complex clinical issues and advises on justification required for continued stay, medical necessity and utilization management.
• Provides for development and dissemination of required protocols, policy and procedures to support revenue cycle goals and compliance with regulations.
• Participate in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management and other related areas as requested.
• Obtains familiarity and working knowledge of standard published criteria such as MCG/InterQual and applies professional judgment and patient specific variables as may be necessary or justifiable.
• Facilitates local system utilization management training and education to Boards, MEC and medical staff departments as required.
• Provides for coordination and improvement in QIO audits.
• Develops statistical reports related to revenue improvement and denial reduction within scope and as requested by Local System Boards, MEC and other local system committees.
• Work with Human Resources on orientation, orientation handbook, compliance, scheduling, training, client engagement, quality and dashboards.
• Collaborate with other departments, attend company meetings and coordinate and provide updates on new processes, policies and procedures.
• Deliver bi-monthly and yearly evaluations.
• Lead weekly, quarterly meetings and develop webinar presentations.
• Grow Physician Advisory program through speaking at conferences, webcasts and podcasts.
• Collaborate with payors to establish strategies to work together.
• This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation.

• Legally Required License / Certification (Ex: MD, RN, LPN, etc.) ONE CERTIFICATION PER FIELD

• Ensemble Required License / Certification (Ex: CRCR) ONE CERTIFICATION PER FIELD
• CRCR or other approved job relevant certification within 9 months of date of hire
• Or other approved job relevant certification.

Desired Education

Education Leve/Preferred Area of Study

• Post Graduate Degree or Equivalent Experience
• Medicine