Medical Director, Physician Advisor Program

Position summary

The Medical Director, Utilization Review/Physician Advisor Program is a key member of UW Health’s leadership team and is charged with meeting the organizations goals and objectives for assuring the effective, efficient utilization of health care services.

The Medical Director, Utilization Review/Physician Advisor Program will develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, appropriate physician coding and documentation requirements.

The Medical Director, Utilization Review/Physician Advisor Program works closely with medical staff leadership, the entire medical staff, all areas of resource management, case management, social services, discharge planning and utilization management to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided. This includes working with hospital leadership in developing care management protocols with physicians and others to optimize length of hospital stay and efficient management of resources, ensuring patients are in the appropriate hospitalization status, supporting documentation, coding improvements and compliance, and monitoring the appropriate use of diagnostic and therapeutic modalities.

Roles and responsibilities

The expectation of UW Health Medical Directors is to provide leadership to their area(s) that results in the consistent and successful delivery of “Remarkable Healthcare” that is high quality, cost efficient, and delivered in a way that is highly satisfying for patients, providers, and staff.

Medical Directors are expected to develop and demonstrate all UW Health Leadership Competencies and lead within their area(s) using the UW Health Way. Each Medical Director has areas of emphasis for their role but ensuring the provision of “Remarkable Healthcare” is a shared responsibility. In support of delivering “Remarkable Healthcare”, Medical Directors promote excellence in both culture and performance management.

Medical Directors are expected to perform standard work that supports this achievement. Each Medical Director will work with their administrative partners to establish and maintain a culture that values and embraces the team-based care model. This partnership will create a work environment that is patient-centered, values each team member as uniquely important, is collegial, collaborative, and promotes job satisfaction and retention. Each partnership will maintain in-depth knowledge of their area’s performance on key measures as defined by organizational leadership. The partners will identify opportunities for improvement, maintain an active action plan, and use the UW Health Way to drive changes that improve performance in needed areas. Daily:

  • Lead with humility and a focus on service to others (staff, providers, patients, and organization).
  • Lead by example in knowing, communicating, supporting, and reinforcing the goals we are trying to achieve in aligning with our UW Health Strategic Plan.
  • Maintain a positive and optimistic attitude while maintaining open communication channels with all providers and staff.
  • Ensure that UW Health standard processes and clinical guidelines are communicated, followed, and Service Standards are being met.
  • Address and resolve problems and conflicts that arise in a timely fashion.

Physician support, education, and collaboration

  • Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources, and alternative levels of care.
  • Provide education to physicians and other clinicians regarding inappropriate admissions and create action plans to address this issue.
  • Provide physician coaching and on-going education on appropriate clinical documentation improvement and care standards as may be appropriate.

Physician liaison:

  • Conducts physician education sessions to share data, trends, practice patterns, and other relevant information as requested.
  • Advocates for physician accountability for efficient patient care management.
  • Investigates avoidable delay concerns referred by case management staff that effect patients’ outcomes during their hospital stay.
  • Demonstrates positive outcomes through interventions with attending or consulting physicians that delay care and affect the length of stay or avoidable delays, etc.
  • Identifies denial trends and works with the medical staff and hospital administration to resolve the issue.
  • Reports practice pattern trends and opportunities to service line or department specific meetings at the request of the CMO, Director of Care Management, or hospital leadership.

Organizational process improvement:

  • Identify quality, safety, patient satisfaction, and efficiency issues leading to sub-optimal care. Take appropriate action to resolve.
  • Promote and educate healthcare team on a team approach to patient care. Promotes coordination, communication, and collaboration among all team members.

Medical informatics support:

  • Optimizes EMR processes to facilitate utilization management processes as much as possible.
  • Works with the IT leadership team to ensure the system appropriately supports the physician’s ability to provide best practice medicine by creating logical processes and providing the necessary practice guidelines.
  • Assists with order and order set development, review, and implementation to coordinate quality, efficiency, and utilization of the order sets, as requested.

Outcomes and deliverables:

  • Submits monthly record of performance metrics or data as requested to the CMO (or direct report).
  • Maintains documentation of the number of interventions and resulting outcomes or decisions.
  • Documents education sessions for medical staff on trends, practice patterns, or relevant information.
  • Tracks and reports appeal and denial results where Physician Advisor intervention was required.

Requirements:

Education Minimum MD or DO Preferred Work Experience Minimum 3 years clinical practice experience Preferred Licenses & Certifications Minimum Current license Preferred

  • Board certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP).
  • Physician Advisor Sub-Specialty Certification by ABQAURP.
  • Member, American College of Physician Advisors.

About the Greater Rockford Area

Rockford and northern Illinois offer world-class attractions, outstanding recreation opportunities and beautiful parks — all at a cost of living significantly below those of most metropolitan areas. And for a quick visit, Chicago, Milwaukee and Madison are each just 90 minutes away or less. The Greater Rockford area offers superb cultural, recreational and outdoor amenities along with an eclectic arts community of theater, symphony, museums and dance. With an award-winning park district, Rockford also offers unrivaled outdoor recreation, markets and ethnic festivals, plus Golf Digest-ranked golf courses, endless bike trails and extensive indoor and outdoor sports centers. In addition, we have excellent private, parochial and public school options, including the renaissance Gifted Academy with graduates ranked in the top 5 percent nationally.

Contact information

For more information on how you can advance your career with UW Health Northern Illinois or to submit your CV and cover letter for consideration, please contact Jessica Marquez at jmarquez@uwhealth.org or call (779) 696-7073.