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Physician Advisor

Req #:  114305
Facility:  Christ Medical Center
Department:  Management/Supervisory
City:  Oak Lawn
Posting Budget Status:  Day/Night
Shift Type:  Full Time - Permanent
Posting FTE:  1

 

Advocate Christ Medical Center is part of Advocate Health Care, one of the nation’s leading health care networks. A not-for-profit, 749-bed, premier teaching institution with more than 1,200 affiliated physicians, Christ Medical Center is one of the major referral hospitals in the Midwest for a number of specialties, including cancer care; cardiovascular services; heart, kidney and lung transplantation; neurosciences; orthopedics; and women’s health. The hospital provides emergency care for more than 100,000 patient visits annually and has one of the busiest Level I trauma centers in Illinois.

 

 

Overview

The Physician Advisor functions with or by the authorization of the Medical Director - Physician Advisor/Care Management. Conducts clinical review on cases referred by Care Management staff /Social Work/Utilization management and/or other health care professionals in accordance with the hospitals objectives for assuring quality patient care and effective, efficient utilization of heath care services appropriate level of care, monitoring the appropriate use of diagnostic and therapeutic modalities, and to meet regulatory requirements. Interacts with Medical Staff members, APP Medical Directors and Medical Directors of payers to discuss the needs of patients and alternative levels of care. In collaboaration with the Medical Director acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay and use of resources. Acts as consultant and resource to the Medical Staff regarding federal and state utilization and quality regulations.

Qualifications

  1. Graduate of an accredited medical school.
  2. Additional education in Quality and Utilization Management through continuing medical education. programs and self-study.
  3. Current Illinois license to practice medicine and eligibility for active membership on the hospital’s medical staff.
  4. Minimum of 5 years recent experience in clinical practice.
  5. Utilization Management experience as a member of the UM oversight committee or past Physician Advisor experience preferred.
  6. Knowledge of National Medical Criteria

 

Accountabilities

  1. Care Management
    1. Accountable for case management outcomes
    2. Ensures efficient patient care
    3. Provides consultation and education to nurses, social workers and case management associates
    4. Promotes efficient use of health resources
    5. Reviews outlier cases and recommends actions to expedite appropriate outcomes
    6. Communicates with Medical Center leadership on issues pertaining to service delays
    7. Attends length of stay meetings
  2. Utilization Management
    1. Serves on Utilization Management Committee
    2. Reviews and assists cases where non-coverage issues surface
    3. Assists with denial management appeals and processes
    4. Reviews causes of delays in transition to appropriate next level of care
    5. Reviews daily cases referred by Utilization Review associates
    6. Acts as clinical expert to provide facilitation of patient care and services
  3. Clinical Documentation
    1. Provides support and education to appropriate Department heads regarding clinical documentation
    2. Provides support and education regarding level of care orders and completion of order certification
    3. Provides support and education pertaining to medical necessity criteria and documentation of such
    4. Serves as department champion for the documentation integrity program and initiatives at the Medical Center.

 

 

About Advocate Health Care

 

Advocate Health Care, named among the nation’s Top 5 large health systems based on quality by Truven Analytics, is the largest health system in Illinois and one of the largest health care providers in the Midwest. Advocate operates more than 250 sites of care, including 12 hospitals that encompass 11 acute care hospitals, the state’s largest integrated children’s network, the state’s largest emergency and Level I trauma network, one of the area’s largest home health care companies, and the region’s largest medical group. Advocate Health Care has 4 teaching hospitals and is a not-for-profit, mission-based health system affiliated with the Evangelical Lutheran Church in America and the United Church of Christ.


Nearest Major Market: Chicago