PHYSICIAN ADVISOR

Southwest General Health Center is a 352-bed community hospital located in Middleburg Heights, Ohio. One of the last standing community hospitals in Northeast Ohio, we partner with University Hospitals and other local community organizations to provide a full range of services to all who need us. We are certified as a Level III Trauma Center and a Primary Stroke Center, and have been serving our community for over 100 years!

At Southwest General, we believe in the power of teamwork, creating a family-like environment, ensuring a work-life balance, and providing meaningful work to make a real difference in people’s lives.

We value our employees as much as our patients, offering a supportive work culture that encourages growth, development and collaboration. We’re committed to building a team that works together, supports each other, and ultimately, saves lives every day.

At Southwest, you are family.

See why working at Southwest General can be a choice you’ll love!

POSITION SUMMARY :

The Physician Advisory (PA) is responsible for facilitating the efficiency of care delivered through the review of utilization data, conducting clinical reviews on cases referred by case management (CM), social work (SW), and / or other health care professionals to meet regulatory requirements and hospital objectives for assuring quality patient care. The PA meets with case management, social work, and health care team members to discuss selected cases and make recommendations for care, interacting with medical staff and medical directors of third party payers to discuss the needs of patients and alternative levels of care.

The PA acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources during hospitalization. The PA further acts as a resource for the medical staff regarding federal and state utilization and quality regulations. The PA works with the medical staff leadership, the attending medical staff and case management, social work and other interdisciplinary team members to develop and implement procedures to optimize use of hospital services for all patients while also ensuring the quality of care provided. This includes developing case management protocols, working with physicians and others to reduce hospital length of stay, ensuring patients are in the appropriate level of care, and monitoring the appropriate use of diagnostic and therapeutic modalities The PA will also act as a liaison between the CDI professional, HIM, and the hospital’s medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, in addition to DRG assignment.

MINIMUM QUALIFICATIONS :

Education :

Graduate of an accredited medical school. Completion of specialty residency preferably in internal medicine or family practice with subsequent board certification. Subspecialty or other post-residency fellowship desirable but not required. Additional education in quality and utilization management through continuing medical education programs and self-study preferred.

Required length of experience :

• Minimum of five (5) years recent experience in clinical practice. Utilization management experience as a member of the UM oversight committee or past physician advisor experience preferred.
• Three (3) to five (5) years experience in a hospital wide position involving quality / case management, utilization review, resource management, or medical staff governance.
• Demonstrated ability to build rapport with medical staff and hospital leadership to obtain necessary approvals of new strategies for utilization management.
• Knowledge of current medical literature, healthcare delivery systems, medical staff procedures, healthcare financial / reimbursement issues related to medical necessity, level of care, utilization / resource management and related medicare compliance.
• Demonstrated ability to deliver high-quality, cost effective, efficient patient care services and familiar with ICD-10 Methodology and required documentation.

Required licensure, certification, and / or registry :

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