Description

Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region.

Position Overview

ThePhysician Advisor collaborates with the Utilization and Care Management Departments, Organization Leadership as well as with staff physicians to ensure compliance with the organizational Utilization Management Plan.

Essential Functions

Develop and cultivate positive and productive working relationships with other Corewell Health personnel , and promote a culture of safety, teamwork, compassion, collaboration, clarity, curiosity, and courage.

Demonstrate a commitment to service and distinctive, personalized care with both internal customers (coworkers, fellow employees, hospital staff, etc.) and external customers (patients, family members, referring physicians/specialists, etc.), while striving to exceed customer expectations.

Assist in meeting operational, financial, and patient satisfaction goals.

Timely completion of all specific competencies and annual organizational mandatories.

The Physician Advisor will collaborate with the Utilization and Care Management Departments as well as physicians to provide the following functions:

• Improved accuracy of determining patient status upon hospital entry.
• Improved management of observation patients including reviews for consideration of early discharge or change to inpatient status.
• Improved timeliness of case reviews not meeting utilization management screening for inpatient criteria.
• Improved management of concurrent utilization management denials.

In addition, the Physician Advisor will collaborate to provide these additional functions:

• Acting as consultant and resource to the medical staff regarding federal and state utilization and quality regulations relative to appropriateness of hospitalization, continued stay, and use of resources
• Providing feedback to attending and consulting physicians regarding level of care, length of stay, and quality issues.
• Seeking additional clinical information from the attending and consulting physicians.
• Recommending and requesting more complete medical record documentation.
• Participating in review of long stay patients, in conjunction with the Care Management Leadership, Care Management Team and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care.
• Acting as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate.
• Providing education to physicians and other clinicians related to regulatory requirements, appropriate utilization , and alternative levels of care.

Participate in on-call and weekend coverage, as required by the Department.

Document in the patient's medical record in a manner consistent with hospital, payor, and regulatory standards.

Actively participates in safety initiatives and risk mitigating measures where appropriate and completes all position and unit safety related competencies and requirements on a timely basis.

Qualifications

• Doctorate. Required
• License -Physician (MD) - State of Michigan Upon Hire required Or
• License -Osteopathic Physician (DO) - State of Michigan Upon Hire required
• CRT-DEA Registration - State of Michigan. Preferred
• CRT Physician Advisor Certification- American College of Physician Advisors within one-year Preferred OR
• CRT Physician Advisor Sub-Specialty certification (CHCQM-PHYADV)- American Board of Quality Assurance and Utilization Review Physicians within one-year Preferred OR
• CRT ACMA Physician Advisor Certification- American Case Management Association/Association for Physician Leadership in Care Management (APLCM) within one-year Preferred

About Corewell Health

Our new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value. Through compassion, collaboration, clarity, curiosity, and courage, we make anything and everything possible. Through our people, we care for the whole person with respect, dignity, and love. Everyone deserves opportunities and resources for better health. Everyone deserves our relentless pursuit to innovate and always do better. Everyone deserves to have a community be a great place to live, work, learn and play. We believe health and well-being should be within reach for all. We believe the system to support the entire health and wellness journey starts with prevention. We believe that together we will make a difference. Together, we are here to make health better for everyone. Together, we are Corewell Health.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

Primary Location
SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd

Department Name
Utilization Management - Diversified East WB Mkt

Employment Type
Full time

Shift
Variable (United States of America)

Weekly Scheduled Hours
40

Hours of Work
8 a.m. to 5 p.m.

Days Worked
Monday to Friday

Weekend Frequency
Variable weekends

CURRENT COREWELL HEALTH TEAM MEMBERS - Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.