Built-in 1973 Dignity Health Methodist Hospital of Sacramento is committed to providing daily excellence in health care for residents of Sacramento’s southern suburbs including the Elk Grove Wilton and Galt communities. Methodist Hospital is home to a 158 acute-care bed facility with 1120 employees 283 medical staff and 29 Emergency Department beds. Methodist Hospital also owns and operates Bruceville Terrace – a 171-bed sub-acute skilled nursing long-term care facility adjacent to the hospital that provides care for the elderly as well as those requiring extended recoveries. Methodist Hospital is home to the Family Medicine Residency Program an accredited and nationally recognized program which provides resident physicians with specialty training in primary care family medicine. Together the hospital and residency program implemented a ground-breaking curriculum addressing the identification treatment and assistance of human trafficking victims and created a one-of-a-kind health clinic for victims the Human Trafficking Medical Home.

The Physician Advisor plays a critical role in promoting evidence-based standards of medical care while maintaining appropriate utilization of Hospital resources. Emphasis is on facilitating communication between the Department of Care Coordination, Medical Staff, Nursing Staff, and Administration regarding systems-based practice, regulatory and quality considerations in the delivery of medical care. The Physician Advisor plays a key role in the following: advocating for the best and most efficient care for Hospital patients; removing barriers to care; working with attending physicians to facilitate the care of the patient; and advocating for, supporting, and enhancing the clinical credibility of the Department of Care Coordination's utilization and compliance activities. The Physician Advisor may report directly to the VP Medical Affairs, Chief Medical Officer, or the Service Area Chief Physician Executive as determined by either the Hospital President or the Service Area SVP of Operations. Physician shall participate in an annual performance evaluation using performance metrics adopted by Hospital.

Responsibilities
1 Develops Relationships.
1.1 Shows a proactive willingness to engage in ambiguous or conflict situations.
1.2 Respects physicians and strives to work collaboratively with the medical staff.
1.3 After reviewing the Job Description, HR policies, UR Plan and other Case Management related documents, discusses expectations of the role with the accountable executive, administrators and the Case Management administrator.
1.4 Meets with each staff person in the case management department to begin to establish a working relationship.
1.5 Meets with key personnel in the business office, admitting, medical records (HIM), education, nursing, key physicians, and ancillary services.
1.6 Develops relationships and meets with key individuals on the medical staff.
1.7 Communicates teamwork, caring and compassion.
1.8 Understands that negotiations, especially inside a medical staff, involve long-term relationships.
2 Seeks Training / Information / Knowledge
2.1 Communication courses such as "Crucial Conversations".
2.2 Review current legal, ethical, medical by-laws and regulatory parameters that influence the organization, as well as the systems and staff in place to address them.
2.3 Develops familiarity with the InterQual® or currently used criteria set.
2.4 Attends formal training or seeks learning from the ACPE, ABQAURP, IHI, QIO or other authority on cost and quality.
2.5 Participates in suggested training sessions.
3 Participates in the Case Management Process including Utilization Review and Proactive Discharge Planning.
3.1 Articulates case management as a specialty process in itself that reflects national standards of care.
3.2 With the Director of Case Management, Executive Lead and Medical Staff Leadership, provides input, reviews and evaluates the organization-wide case management program.
3.3 Part of a physician team responsible for daily availability for rounds and / or other daily case management and utilization review activities.
3.4 Ensures that physicians covering the PA are familiar with the PA's approaches and provides follow-through, working as a team providing trade off information and feedback to each other.
3.5 Provides secondary review and the application of medical rationale and decision making to referred cases and provides outcome of secondary review for documentation in the Utilization Review records (either paper or MIDAS/CERMe) of the individual patient.
3.6 Participates in activities as needed to actively manage avoidable days and improve efficiency of consultations, tests and surgery scheduling, hospital and physician weekend efficiency, last minute discharges and over and under utilization.
3.7 Leads, co-leads and advises competent leaders in case management activities, articulating the need that there should be responsibility assigned for next steps.
3.8 When appropriate, uses a panel of physician experts in areas outside own expertise to bring specialty knowledge to bear on complex situations.
3.9 Reviews and participates as necessary in the development and refinement of order sets, clinical paths, algorithms or protocols, core measures and other forms of structured care methodologies as requested.
3.10 Works side by side with case manager, giving direction with criteria, educating on treatment flow, supporting case
management to foster trust within medical staff.
3.11 Communicates with fellow physicians with conviction and respect and resolves patient management issues or refers on to external review organization for review including the designated Quality Review Organization and external Medical Directors.
3.12 The Physician Advisor in addition to assisting in the review of specific cases recognizes and trends Patterns of Physician utilization and communicates patterns and trends to the Utilization Management Committee and other Medical Staff Committees as indicated.
3.13 Takes a proactive approach and follows up on actions requested of himself / herself by the case management team.
3.14 Effectively participates in communication as needed with physicians, organizations, payers and IPA's in activities such as RAC appeals, audits and secondary review. Advises medical staff in and facilitates case management and utilization review communication with the medical staff.

4 Advises medical staff in and facilitates case management and utilization review communication with the medical staff.
4.1 Articulates the importance of physicians' cooperation in working with the mission of the hospital and health system including stewardship, efficiency of care and support of case management, clinical social work and all hospital disciplines.
4.2 Articulates the importance of physicians' cooperation in working with the mission of the hospital and health system including stewardship, efficiency of care and support of case management, clinical social work and all hospital disciplines.
4.3 Values the importance of physician involvement and participation in the development of structured care methodologies.
4.4 Identifies quality issues and refers cases to the established peer review processes.
4.5 Based on knowledge, is a valued member of peer review process for purposes of resource and education.
4.6 Effectively communicates the relationship between quality, risk and length of stay.
5 Fosters environment of caring and compassion.
5.1 Takes care of self so can take care of others.
5.2 Appreciates the burden of patient's illness and stresses of the care team.
5.3 Gives clear, concise and consistent messages about making patient-centered decisions to all constituencies.
6 Mentors Physicians, Case Managers and Social Services and other disciplines.
6.1 Brings pertinent current medical and health policy literature to the attention of the case management department and the Executive Team.
6.2 Integrates the principles of continuous quality improvement and relevant current literature to raise the standard of physician practice.
6.3 Creates and manages a system for the ongoing education and development of medical staff as a group and individually.
6.4 Leads and teaches case managers and hospital teams to improve processes.
7 Produces, analyzes and reports / communicates data.
7.1 Utilizes produced standard utilization and case management reports to promote efficiently delivered quality care.
7.2 Identifies trends, such as in avoidable days or re-admissions, and recommends an approach to better analyze and / or address them.
7.3 Provides Utilization Management Committee or appropriate Medical Staff Committee with ongoing validated information about the treatment and flow of patients throughout all levels of care.
7.4 Educates physicians and medical staff regarding case management and utilization review data.
8 Leadership
8.1 Works through ambiguous situations in order to clarify direction and successfully manage change.
8.2 Provides decision support as needed by the staff and Executive Team.
8.3 Adjusts to strategic plan changes as important new risks and needs are understood.
9 Communication
9.1 Has access to the Dignity Health e-mail system to retrieve regular updates and communication with case management.
9.2 Has access to MIDAS/CERMe if a live facility to receive and respond to PA referrals and to provide documentation of secondary review determinations.
9.3 Facilitates appropriate outcomes through communication with Case Managers, attending physician(s) and other members of the multidisciplinary team.
9.4 Regularly provides feedback to the CM Director regarding the appropriateness and quality of referrals initiated by the Case Managers.
10 Performance Metrics
10.1 Will respond to Case Management within 1 hour.
10.2 Appropriately communicated cases received by review by 2 pm will be reviewed the same day, Monday through Friday 90% of the time.
10.3 Based on feedback from Case Managers, consistently communicates with attending physicians(s) and / or consultants on referred cases when the PA agrees with the Case Management determination and the Case Manager has either previously communicated with the physician or attempted to do so.
10.4 Documents determinations for 100% of cases referred in writing to the PA in MIDAS/CERMe or on a paper referral log.
10.5 Communicates PA coverage 100% of the time when not available.
10.6 Receives feedback from Case Management Questionnaire regarding Physician Advisor.
10.7 Participates in clinical decision -making leading to decision to forego billing ("Zero-Bill").
11 Perform other related duties as needed or assigned.
11.1 Meets expectation of the job standard.

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