Physician Advisor - Centralized Utilization Review - FT Days - MHS

Memorial Healthcare • Rockville, MD

105d

About The Position

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. The position ensures documentation, data capture and opportunities for utilization are compliant, accurate and consistent.

Requirements

• Medical Doctor (Required)
• Medical Doctor License (ME LICENSE) - State of Florida (FL)
• Osteopathic Physician License (OS LICENSE) - State of Florida (FL)
• Minimum of 1 year of work experience in a clinical setting
• Graduate of a medical school approved by the Council on Medical Education of the American Medical Association.

Nice To Haves

• Prior experience in Utilization Management with hospital system or health system preferred.

Responsibilities

• Makes decisions on referred individual patient cases regarding: Pre-admission, authorization, Medical necessity and services/setting, transfers, appropriateness of admission, and continued stay.
• Conducts peer to peer discussions with health plans when required.
• Serves as a resource to the medical staff for Utilization Review activities.
• Educates and communicates to the Medical staff the benefits/need for utilization review and documentation.
• Performs regular, follow-up and focused chart audits/reviews (concurrent and retrospective) for the purpose of assessing the accuracy of clinical documentation and utilization.
• Ability to work weekends and holidays as needed.
• Works in collaboration with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to maintain and improve utilization and documentation efforts.

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees