Physician Advisor

The Physician Advisor will be expected to dedicate the time stipulated in their contract to the successful performance and completion of the above referenced administrative duties.  Clinical responsibilities will be at the discretion of the home clinical department.

Provides regular input into the strategic planning and resource allocation processes of WVU Medicine as it applies to Utilization Management.

Conducts physician education sessions to share data, trends, practice patterns, and other relevant information as requested.

Investigates avoidable delay concerns referred by case management & utilization management staff that effect patients’ outcomes during their hospital stay.  Investigates and studies new developments in medical practice models, regulatory requirements, and third party coverage as assigned by the Chief. 

Participates in the development and implementation of new patient care programs, and consideration of hospital/medical staff ventures. 

Identifies denial trends and works with the medical staff and hospital administration to resolve the issue.  Reports practice pattern trends and opportunities to service line or department specific meetings at the request of the CMO or hospital leadership. 

The Physician Advisor will be required to submit quarterly time sheets verifying successful completion of the number of contractually agreed upon hours to this pursuit. 

He/she will be a credentialed member of all system hospitals.  The physician advisor will travel to and be a consulting representative.  He/she will also represent Utilization Management at various hospital assigned committees. 

Other duties may be assigned.

Assures medical staff compliance with medical staff bylaws, rules, and regulations policies and procedures as they pertain to utilization management.  In concert with the Chief receives, investigates, and where possible resolves conflicts related to Utilization Management.

Provides education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources, and alternative level of care.

Provides education to physicians and other clinicians regarding inappropriate admissions.

Assists WVU Medicine and related affiliated operations in meeting regulatory guidelines, licensure requirements, and in achieving quality improvement objectives.  Maintains an awareness of regulatory standards guidelines as well as clinical standards for federal programs and state licensure requirements, including proposed changes.  Maintains an awareness of regulations, policies, procedures, and standards for third party payers.

Participates in information technology development to allow feedback to physicians regarding practice patterns, and performance and resource utilization.  Assures proper analysis of data occurs to identify patterns and trends, and ensures reporting of the ongoing results.

Doctorate of Medicine from an accredited School of Medicine or Osteopathy and board certified by a board recognized by the American Board of Medical Specialties. 

Holds or eligible for Medical licensure in the State of West Virginia.

Minimum 5 years clinical experience in the practice of medicine is preferred.

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.