Physician Advisor, Utilization & Quality Improvement

2810 Douglas Hospital, Inc.; United States; On-site; USD 150,000 - 230,000; Full time

Job summary

Wellstar Health System in Georgia seeks a Physician Advisor who reports to the Vice President Medical Affairs to improve quality, utilization, patient satisfaction and efficiency through performance improvement and education initiatives across WHS facilities.

The PA will conduct clinical reviews for commercial and Medicare Advantage plans, lead readmission reduction efforts, assist with denial management, and collaborate with physicians, care coordination and administration to optimize care

Qualifications

• MD/DO required; MBA/MHA preferred.
• Minimum 8 years clinical experience; 1–3 years Utilization Management.
• Board certification in specialty; Health Care Quality certification preferred.

Responsibilities

• Assist with level of care and length of stay management across inpatient/outpatient settings.
• Lead Readmission reduction initiatives with governance chairs and VPMA.
• Support denial management and concurrent reviews with Care Coordination leadership.
• Review documentation to ensure medical necessity and appropriate level of care.
• Collaborate with CDS/CDI for physician queries and documentation improvement.
• Engage with Medical Director(s) to address throughput, LOS, and care pathway barriers.
• Lead or co-lead Complex Care Rounds and contribute to care planning for complex populations.
• Participate in ongoing education on payer utilization matters and clinical practice trends.

Skills

Clinical leadership

Utilization management

Quality improvement

Regulatory knowledge

Healthcare communication

Education

Doctorate in Medicine

Doctorate in Osteopathic Medicine

MBA or MHA preferred

Job description

Wellstar Health System in Georgia seeks a Physician Advisor who reports to the Vice President Medical Affairs to improve quality, utilization, patient satisfaction and efficiency through performance improvement and education initiatives across WHS facilities.

The PA will conduct clinical reviews for commercial and Medicare Advantage plans, lead readmission reduction efforts, assist with denial management, and collaborate with physicians, care coordination and administration to optimize care