Physician Advisor: Utilization & Quality Excellence

Wellstar Health System, Inc.; LaGrange (GA); On-site; USD 190,000 - 290,000; Full time

Job summary

Wellstar Health System, Inc. is seeking a Physician Advisor to report to the Chief Medical Officer and impact quality, utilization, patient satisfaction, and efficiency through performance improvement initiatives.

The role collaborates with Care Coordination, Nursing, and administration to ensure medical necessity and appropriate levels of care across Wellstar facilities. Key responsibilities include leading readmission reduction efforts, reviewing clinical records for proper documentation, and

Qualifications

• MD/DO required.
• Board certification in specialty preferred.

Responsibilities

• Lead utilization management and clinical reviews for payer and regulatory compliance.
• Collaborate with Care Coordination/Case Management to optimize patient flow and resource use.
• Lead Readmission reduction initiatives and participate in Denial management processes.
• Provide timely consultation and clinical expertise to ensure appropriate level of care and medical necessity.
• Develop and implement clinical guidelines, order sets, and pathways in collaboration with hospital leadership.
• Engage with Quality and Peer Review processes and regulatory reporting as needed.

Skills

Verbal and written English

Positive attitude

Organizational skills

Multi-tasking

Leadership of physicians

Time management

Analytical skills

Education

Doctorate in Medicine (MD) or DO

MBA or MHA preferred

Job description

Wellstar Health System, Inc. is seeking a Physician Advisor to report to the Chief Medical Officer and impact quality, utilization, patient satisfaction, and efficiency through performance improvement initiatives.

The role collaborates with Care Coordination, Nursing, and administration to ensure medical necessity and appropriate levels of care across Wellstar facilities. Key responsibilities include leading readmission reduction efforts, reviewing clinical records for proper documentation, and