Behavioral Health Physician Advisor (Remote)

Carle Health is seeking a Physician Advisor to help oversee the efficiency of care for our Behavioral Health team over the West, Central, and East regions in Central Illinois.

• Part-time position (.5 FTE and 100% Virtual)
• The Behavioral Health Physician Advisor is responsible for conducting clinical case reviews referred by the Utilization Management Team, the Case Management Team, the Clinical Denial Management Team, and other health care professionals.
• The Behavioral Health Physician Advisor, in accordance with Carle Health’s objectives, will participate in discussions with payer physicians to ensure efficient and appropriate utilization of hospital services for their assigned patient population.
• The Behavioral Health Physician Advisor can, at times, serve as a consultant and as a resource for attending physicians in individual settings as well as group meetings such as the hospitalist meetings related to their decisions around hospital utilization, appropriate level of care, and continued stays.
• The Behavioral Health Physician Advisor is expected to participate in regular scheduled and ad hoc meetings related to utilization management, case management and clinical denials management.
• The Behavioral Health Physician Advisor is also expected to onboard the new providers regarding utilization and case management objectives.
• Conducts medical record review in appropriate cases for medical necessity of hospital admission, continued hospital stay, adequacy of discharge planning and quality care management.
• Provides education to physicians and other clinicians related to improved clinical documentation, regulatory requirements, appropriate utilization, alternative levels of care, and community resources.
• Works collaboratively with the Clinical Denial Management team, the Utilization management team and the Clinical Denial Management team in defending payor claims denials for medical necessity through coordination of and participation (when appropriate) in the appeal process.
• The Physician Advisor functions with or by the authorization of the Chief Medical Officer and works with our Utilization Management RN team, Clinical Denials Management team and the Physician Advisor Team which is comprised of five other physicians.
• Conducts clinical review on cases referred by Care Management staff /Social Work (remove) Utilization management and Clinical Denials Team/or other health care professionals in accordance with the hospital’s objectives for assuring quality patient care and effective, efficient utilization of heath care services, appropriate level of care, monitoring the appropriate use of diagnostic and therapeutic modalities, and to meet regulatory requirements.
• Interacts with Medical Staff members, APP Directors and Medical Directors of payers to discuss the needs of patients and alternative levels of care.
• Acts as consultant and resource to attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay and use of resources.
• Acts as consultant and resource to the Medical Staff regarding federal and state utilization and quality regulations.

Candidate Qualifications:

• MD/DO, board-certified in Psychiatry
• Active Illinois medical license or ability to obtain
• 5 or more years of Psychiatric Clinical practice experience required
• 1 or 2 years experience as a Physician Advisor or similar role

Champaign-Urbana has been defined as a micro-urban community, meaning we have many of the amenities of a much bigger city, with the feel of a smaller town. Almost equidistant to Chicago, St. Louis and Indianapolis for fun weekends away, the area offers excellent schools, a great downtown scene, the University of Illinois, Big 10 sports and an exciting college town atmosphere, including Krannert Center for the Performing Arts.