Functions as a representative of Munson Healthcare serving as a resource to the Patient Care Management ( PCM)/Utilization Management(UM)/ Clinical Documentation Integrity (CDI) staff to promote evidence-based practice, appropriate resource utilization, and compliance with all state accrediting and federal regulations governing medical necessity, continuing care, discharge planning, and documentation.
The Physician Advisor functions as a peer to physicians and a consultant to PCM/UM/CDI and administration. Conducts clinical review of cases referred by PCM/ UM/ CDI 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.
Intervenes when practice patterns 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 Munson Healthcare as a whole.
Reports directly to the Lead Physician Advisor for Munson Healthcare.
Physicians & Advance Practice Providers Employed by or under a Professional Services Agreement with a Munson Healthcare entity.
550+ Physicians and Advance Practice Providers
65 Practice Sites
Primary and Specialty Care
Inpatient and Ambulatory Care
$120M Net Revenue Annually
Area of Continued Strategic Growth for MHC
MINIMUM JOB SPECIFICATIONS
Hold and maintain an unrestricted medical license in the state of Michigan.
Be a member of the medical staff.
Possess/acquire a solid foundation, knowledge, and/or experience in the areas of utilization management, case management, clinical documentation integrity, quality improvement, and patient safety.
Possess/acquire a working knowledge of Munson Healthcare operations and administrative standards and policies.
Strong computer skills and working knowledge of the EMR.
Familiarity with MCG/InterQual placement status criteria is preferred.
STANDARD QUALIFICATIONS
Education / Training:
MD or DO
Certification, Licensure, Registration :
Member of the American College of Physician Advisors (ACPA) preferred.
Board Certification by the American College of Physician Advisors ( ACPA), American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP), or American Physician Leaders in Case Management ( APLCOM) preferred.
Physician Advisor Sub-Specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred.
ORGANIZATION EXPECTATIONS
Demonstrates behavior that supports the mission of Munson Healthcare.
Demonstrates respect and uses positive interpersonal skills with patients, managers, employees, outside organizations, and the public at all times.
Adheres to all professional and performance expectations set forth within the medical staff bylaws, rules & regulations and complies with all Munson Healthcare established policies and procedures.
Maintains confidentiality of patient care and business matters.
Participates in required orientation and training related to the Physician Advisor role.
Participates in ongoing training and education related to the Physician Advisor role and responsibilities including topics related to Utilization Management, Care Management, Clinical Documentation, 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.
Meets production standards within established time requirements. Work product and performance meets quality standards.
DUTIES AND RESPONSIBILITIES
The Physician Advisor provides timely, clinically, and fiscally effective consultation to PCM/UM/CDI, including concurrent assessment of the clinical situation, determination of next actions, the actions themselves, and all necessary follow-up. Expedite communications of next actions to utilization review specialists, case managers, social workers, physicians, clinical documentation specialists, and other key people involved in caring for individual patients whose cases have been referred for consultation:
Assist staff with clinical review of patients and refer cases to peer review when appropriate
Assist with level of care and length of stay management in a timely fashion
Assist with denial management progress by intervening with payers when necessary
Coordinates with other Munson Healthcare Physician Advisors in PCM/UM/CDI as needed
Documents according to policy
Provide consultation to staff regarding complex clinical issues and advise on justification for continued stay, medical necessity and utilization management
Participates in physician education and outreach efforts.
Provider education in real time for concerns about patient status
Provider education regarding insurance rules and regulations
Participates in educational programs conducted by the Hospital to the extent necessary to ensure the Hospital's overall compliance with accrediting and regulatory requirements
Participates as active member of the Utilization Review Committee and other committees as assigned.
Meets monthly with Lead Physician Advisor.
Must have working knowledge and understanding of PCM/UM/CDI Dashboard and physician profiles.
Upon request, serves as an expert clinical resource on the development and utilization of established clinical guidelines, protocols, standard work, order sets, pathways, and other structured care methodologies.
Brings matters of potential or actual problems in physician practices to the attention of the Chief Medical Officer (CMO) when appropriate if professionally recognized standards of quality care are not met.
Maintains current knowledge of federal, state, and payer regulatory and contract requirements.
Proactively integrates principles of continuous quality improvement to raise the standard of physician practice and ultimately the practice of the hospital and healthcare system.
ABOUT MUNSON HEALTHCARE
Munson Healthcare is northern Michigan's largest and leading healthcare system. Based in northern Michigan, our team of medical experts, award-winning hospitals, and related organizations serve people in 30 counties. Munson Healthcare is comprised of regional referral center Munson Medical Center (Traverse City) and 7 community hospitals: Cadillac Hospital (Cadillac), Charlevoix Hospital (Charlevoix), Grayling Hospital (Grayling), Kalkaska Memorial Health Center (Kalkaska), Manistee Hospital (Manistee), Otsego Memorial Hospital (Gaylord), and Paul Oliver Memorial Hospital (Frankfort). Across the system there are 694 licensed acute care beds and 212 licensed long-term care beds. Most of the region's 540,000 residents can receive comprehensive quality care in or near their local community with access to sophisticated diagnostic technology such as 3D tomography, advanced cancer and heart treatments, and the latest robotic technology, stereotactic radiosurgery, and non-invasive surgical procedures.
As a non-profit healthcare system, Munson Healthcare provides more than $60 million annually (https://www.munsonhealthcare.org/grayling-hospital/about-us/community-benefit-grayling) in:
Community Education
Free, discounted and unreimbursed he
