Physician - Physician Advisor Utilization Management - Corporate

Corewell Health is expanding its Utilization Management team and is seeking a collaborative and clinically driven Physician Advisor to support our East Region. Position Overview The Physician Advisor collaborates with the Utilization and Care Management Departments, Organization Leadership as well as with staff physicians to ensure compliance with the organizational Utilization Management Plan. Essential Functions Develop and cultivate positive and productive working relationships with other Corewell   Health personnel , and promote a culture of safety, teamwork, compassion, collaboration, clarity, curiosity, and courage.   Demonstrate a commitment to service and distinctive, personalized   care with   both internal customers (coworkers, fellow employees, hospital staff, etc.) and external customers (patients, family members, referring physicians/specialists, etc.), while striving to exceed customer expectations.   Assist   in meeting operational, financial, and patient satisfaction goals.   Timely completion of all specific competencies and annual organizational mandatories.   The Physician Advisor will collaborate with the Utilization and Care Management Departments as well as physicians to provide the following functions:    Improved accuracy of determining patient status upon hospital entry.    Improved management of observation patients including reviews for consideration of early discharge or change to inpatient status.    Improved timeliness of case reviews not meeting utilization management screening for inpatient criteria.    Improved management of concurrent   utilization   management denials.    In addition, the Physician Advisor will collaborate to provide these additional functions:    Acting as consultant and resource to the medical staff regarding federal and state utilization and quality regulations relative to appropriateness of hospitalization, continued stay, and use of resources    Providing feedback to attending and consulting physicians regarding level of care, length of stay, and quality issues.    Seeking additional  clinical information from the attending and consulting physicians.    Recommending and requesting more complete medical record documentation.    Participating in review of long stay patients, in conjunction with the Care Management Leadership, Care Management Team and other members of the multidisciplinary team to facilitate the use of the most appropriate level of care.    Acting as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate.    Providing education to physicians and other clinicians related to regulatory requirements, appropriate utilization , and alternative levels of care.    Participate in on-call and weekend coverage, as required by the Department.   Document in the patient’s medical record in a manner consistent with hospital, payor, and regulatory standards.     Actively   participates   in safety initiatives and risk mitigating measures where   appropriate   and completes all position and unit safety related competencies and requirements on   a timely   basis.   Qualifications   Doctorate. Required License -Physician (MD) - State of Michigan Upon Hire required Or License -Osteopathic Physician (DO) - State of Michigan Upon Hire required CRT-DEA Registration - State of Michigan. Preferred CRT Physician Advisor Certification- American College of Physician Advisors within one-year Preferred OR CRT Physician Advisor Sub-Specialty certification (CHCQM-PHYADV)- American Board of Quality Assurance and Utilization Review Physicians within one-year Preferred OR CRT ACMA Physician Advisor Certification- American Case Management Association/Association for Physician Leadership in Care Management (APLCM) within one-year Preferred About Corewell Health   Our new name signals our bold commitment to health and wellness. At our core, we are here to help people be well so they can live their healthiest life possible. Through health care and health coverage, we create more value.​ Through compassion, collaboration, clarity,   curiosity,   and courage, we make anything and everything possible.​ Through our people, we care for the whole person with respect,   dignity,   and love. ​Everyone deserves opportunities and resources for better health.​ Everyone deserves our relentless pursuit to innovate and always do better. ​Everyone deserves to have a community be a great place to live, work, learn and play.​ We believe health and well-being should be within reach for all. We believe the system to support the entire health and wellness journey starts with prevention. ​We believe that together we will make a difference.​ Together, we are here to make health better for everyone.​ Together, we are Corewell Health.   How Corewell Health cares for you Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here . On-demand pay program powered by Payactiv Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! Optional identity theft protection, home and auto insurance Traditional and Roth retirement options with service contribution and match savings Eligibility for benefits is determined by employment type and status Primary Location SITE - Corewell Health Southfield Center - 26901 Beaumont Blvd Department Name Utilization Management - Diversified East WB Mkt Employment Type Part time Shift Variable (United States of America) Weekly Scheduled Hours 20 Hours of Work 8 a.m. to 5 p.m. (20 hours) Days Worked Monday to Friday Weekend Frequency Variable weekends CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only. Corewell Health is committed to providing a safe environment for our team