Associate Lead Physician Advisor

The University of Illinois Hospital & Clinics (UI Health) is seeking a Associate Lead Physician Advisor. The Associate Lead Physician assists Lead Physician Advisor with providing direction, leadership and support to UI Health Physician Advisors (PA). In addition to providing physician leadership, the Associate Lead PA provides expertise related to management of care coordination, length of stay (LOS)/level of care (LOC), patient flow, ancillary service utilization, and clinical documentation improvement (CDI) for the enterprise as well as development and support of potential process improvement initiatives and incentive programming. Acts in the absence of the Lead PA. Responsible for collaborating with the Case Management (CM), Compliance Officer, and CDI departments at the system level to develop and implement standardized policies, and for supporting the PAs in leading physician participation and compliance with responsibilities. Responsible for supporting the Lead Physician Advisor by serving as a resource for the Physician Advisor team. The Associate Lead Physician Advisor will be an active member of the medical staff, with clinical duties of at least .15 FTE

• Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR), DP, LOC and clinical documentation.
• Works with Compliance to interpret new regulatory and compliance requirements and develops standard system-wide implementation plans and policies.
• Works with system Case Management (CM) leadership, Clinical Documentation Improvement leadership, and PAs (as needed) to understand and standardize the implementation of CM and CDI processes and policies, as well as the PA role, activities, and expectations.
• Maintains current knowledge of federal, state, and payer regulatory and contract requirements, and ensures PAs maintain this knowledge as well. Educate and update the medical staff on respective requirements.
• Works with PAs to assess health information technology operational functionality and escalates functional issues as identified.
• Works to ensure initial or continued accreditation through the following:

• Ensure Joint Commission and other accrediting body requirements specific to care coordination are fulfilled, but also understand the linkage between care coordination department’s requirements and those of the integrated delivery system.
• Collaborate with colleagues in quality and other departments to ensure all accrediting body requirements are met.

• Interacts with medical staff by seeking additional clinical information from physicians, discussing patients’ needs, suggesting alternative treatment options and recommending next steps.
• Functions as a consultant and resource to primary (attending) physicians.
• Reinforces evidenced-based medicine best practices and adherence to reduction in clinical variation.
• Participates in weekly Clinical High Risk Meetings to discuss selected cases (e.g., outliers or care/discharge barriers) and makes recommendations regarding care progression.
• Provides support to CDI staff to assist with the clinical documentation query process, physician responsiveness, and comprehensiveness/accuracy of physician documentation (i.e., medical record documentation that reflects the full complexity of the clinical picture).
• Maintains competence and professional development. Maintains license, certification or registration as required. Meets continuous education requirements.
• Demonstrates behaviors that support performance improvement activities.
• Performs other duties and attends committees as requested.
• Provides informal feedback to PAs.
• Observes PAs and provides feedback for standardizing the PA role across the system.
• Serves as a resource for PAs to obtain guidance and assistance.
• Provides coaching to PAs.
• Assists with new PA training and offering professional development support for PAs

Ensures edu

• Graduate of an accredited medical school. Completion of specialty residency (e.g., Internal Medicine, Emergency Medicine, Pediatrics).
• Five years recent experience in clinical practice in a hospital strongly preferred.
• Two years administrative background as physician manager preferred.
• Previous experience as a physician advisor required.
• Experience leading large-scale change efforts preferred.
• Experience in academic medicine, if applicable.
• DO/MD required. Unrestricted Illinois license to practice medicine or Illinois license eligible.
• Certification by American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred.
• Strong clinical acumen.
• Knowledge of case management principles, processes, and their practical application preferred.
• Working knowledge of third-party payor guidelines/medical necessity criteria such as InterQual® (e.g., knowledge of admission criteria for all levels of care).
• Experience with denials management.
• Knowledge of clinical, quality, and administrative facets of the healthcare industry.
• Familiarity with clinical documentation requirements.
• Working knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building this knowledge through experience and partnership with Case Management.
• Excellent communication and presentation skills (both written and oral).
• Teaching and coaching skills.
• Analytical ability and problem-solving skills.
• Working knowledge of electronic medical record.
• Knowledge of process improvement methodology.
• Collaborative attitude to enable a strong partnership with Case Management.
• Clinical credibility among physician peers.
• Persuasive and influential personality.