The Full-Time System Physician Advisor is a lead clinician in partnership with the site physician advisors and Care Management (CM) leadership and staff for managing the efficiency of care of the health system. Acts as resource to Utilization Management (UM) staff and conducts clinical review on cases referred by UM staff and/or other health care professionals in accordance with the system/hospitals objectives for effective, efficient utilization of heath care services/resources, appropriate level of care, monitoring the appropriate use of diagnostic and therapeutic modalities, appropriateness of hospitalization, continued stay and to meet regulatory requirements. Interacts with various payers whose beneficiaries are admitted to Advocate hospitals. Serves as a resource to the denials / appeals staff at SRCO. Interacts with site physician advisors and serves as an additional resource to the site’s Care Management (CM) staff. Must have the ability to cover weekend and holiday shifts as needed.
- Utilization Management: Acts as a clinical expert to provide the facilitation of direct patient care and services for: appropriate level of care options, duplicate and or unnecessary testing, and discharge planning. Daily review of cases referred by UM staff and provides guidance, documents outcomes, and follows up as needed with staff. Discuss cases with site physician advisor and/or attending physician, as needed. Review cases, as appropriate, to identify potential for delay in care delivery that can impact transition to next lower level of care 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 a hospital notice of non-coverage. Serves as second level review for level of care determination for cases referred by UM staff
- Demonstrated knowledge of: Nationally recognized medical necessity criteria. Maintains current knowledge of federal, state and payer regulatory and contract requirements
- Attends continuing education sessions (conferences, journals, webinars, and other related material) and maintains knowledge of trends pertaining to utilization and care management
What You Will Need
- Graduate of an accredited medical school.
- Current Illinois license to practice medicine
- Minimum of 5 years of experience in clinical practice
- Previous Physician Advisor/Care Management experience as a member of the UM oversight committee or equivalent experience
- Additional education in Quality and UM through CME or equivalent experience.
- Knowledge of national medical criteria
- Ability to obtain medical staff privileges at Advocate facility
- Strong interpersonal communication skills
About Oak Brook, Illinois
The Village of Oak Brook is located about 15 miles west of the Chicago Loop and is served by a network of major federal, state, and county roads including the Tri-State Tollway system, the East-West Tollway and the Eisenhower Expressway. The Village's adjacent neighbors include the communities of Villa Park, Elmhurst, Lombard, Oakbrook Terrace, Westchester, Westmont, Clarendon Hills, Downers Grove, and Hinsdale.
About Advocate Aurora Health
Together, we make healthy happen.
Now, as the 10th largest not-for-profit, integrated health system in the nation, Advocate Aurora Health’s combined strength and stability drives us forward. Our integrated delivery model allows our clinicians to offer state-of-the-art, top tier quality care throughout eastern Wisconsin and northern and central Illinois.
Our supportive staff and leadership are committed to an autonomous practice environment and continuously strive to be on the forefront of managing the changing healthcare landscape, advances in technology and innovative approaches to providing impeccable outcomes for our patients.