Physician Advisor

About the role

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

Responsibilities

• Serves as physician expert and provides support to care team and care coordination staff regarding utilization decisions including screening for appropriateness of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource utilization/management, denial management issues, discharge planning (DP) advice, and quality issues.
• Maintains knowledge of government regulations related to utilization review, transition planning, billing, and managing patients and acts as a resource to physicians and staff related to these regulations.
• Perform second level reviews, peer-to-peer calls and advise on continued stay reviews that require additional Physician Advisor input.
• Management of appeals process, post-discharge review, and necessary documentation improvement.
• 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.
• Supports care team, patient placement department and nursing supervisors by assisting with patient placement decisions (as needed), care/discharge delays, and patient throughput.
• Provides support to ancillary services departments (e.g., lab and radiology) by mitigating the inappropriate or unnecessary use of services.
• Participates in daily Escalation Huddles to support care team communication and coordination activities, and to discuss selected cases (e.g., outliers or care/discharge barriers) and makes recommendations regarding care.
• Prepares for and participates in (or ideally, leads) monthly Utilization Management (UM) Committee.
• Documents patient care reviews, determinations, and other pertinent information per hospital/care coordination policies.
• Maintains a consistent professional presence at facility campus to support medical staff and perform daily responsibilities.
• Provides expertise to CDI specialists, enhancing query processes and physician engagement to ensure medical documentation accurately reflect patient care complexity.
• Designs and conducts educational programs for medical and CDI staff, updating training to include the latest clinical guidelines and coding standards.
• Reviews and advises on medical records to ensure documentation quality, addressing gaps and aligning with regulatory and billing standards.
• Develops strategic CDI initiatives aligned with healthcare quality goals and provides clinical expertise on complex cases and documentation standards.

Qualifications

• Education: Graduate of an accredited medical school. Additional education in quality and utilization management through continuing medical education programs and self-study preferred.
• Experience: Minimum of five years recent experience in clinical practice. Utilization management experience as a member of the UM oversight committee or past Physician Advisor experience preferred.
• Physical Demands: Ability to travel to various patient care areas, conference facilities, corporate offices or other sites as requested.
• Supervision Received: Corporate Care Management Leader for Administrative supervision

Skills

• Confidentiality: Demonstrates knowledge of and compliance with all regulatory privacy standards (e.g., HIPAA, Joint Commission); maintains patient and organizational confidentiality.
• Professionalism: Maintains consistent attendance, punctuality, professional appearance; positive attitude; mentor; lifelong learner; understands role limitations; participates in performance improvement; maintains knowledge of hospital systems.
• Communication: Creates welcoming environment; active listening; clear, courteous, respectful communication.
• Accountability: Takes responsibility for actions; provides accurate information; timely updates; adheres to policies; respects property; demonstrates cultural awareness.
• Teamwork: Maintains clean work environment; communicates needs; understands impact; resolves conflicts constructively; appreciates others.

Pay