.0 FTE Enterprise Physician Advisor

As needed.

• Conducts clinical review as appropriate on cases referred by Care Management /Social Work/Utilization management staffand/or other health care professionals to ensure quality patient care and effective, efficient utilization of heath care services,appropriate level of care, and monitors the appropriate use of diagnostic and therapeutic modalities.
• Review cases, as appropriate, to identify potential for delay in care delivery that can impact transition to next lower level ofcare or extend LOS. Discuss case with UM/CM staff, site physician advisor, and/or attending physician, as needed.
• Reviews cases that indicate a need for issuance of hospital notice of non-coverage.
• Demonstrates knowledge of medical necessity criteria and ICD-10 guidelines. Maintains current knowledge of federal, stateand payer regulatory and contract requirements.
• Provides education to physicians and other clinicians related to regulatory requirements, appropriate utilization, andalternative levels of care, community resources and end of life care.
• Collaborates with the medical staff and other health care professionals regarding the individual patient’s plan of care and care goals within proposed / expected timelines and clinical pathways.
• Assists with denial management process including denials prevention work and conducting peer to peer appeals.

• Medicine and Surgery, MD-DO license issued by the state in which the team member practices.

• Doctorate Degree in Medicine.

• Typically requires 3 years of experience in clinical practice. Clinical Documentation Improvement and Utilization Management experience as a member of the UM oversight committee or past Physician Advisor experience preferred. Additional education in Quality, Utilization Management and documentation improvement / integrity through continuing medical education programs and self- study. Knowledge of national medical necessity criteria and ICD-10 coding guidelines.

• Demonstrates knowledge of medical necessity criteria
• Maintains current knowledge of federal, state and payer regulatory and contract requirements
• Strong analytical and decision-making skills
• Must be motivated and self-directed and possess qualities of leadership, interpersonal skills and the ability to communicate
• effectively
• Ability to utilize computer based medical record and other electronic tools in conduction reviews, reviewing data, and
• documenting as appropriate to role.
• Basic computer skills typing 25-20 WPM preferred

• Operates all equipment necessary to perform the job.

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.