Physician Advisor - Centralized Utilization Review - FT - Days - MHS

Memorial Healthcare

19h • Onsite

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. This position ensures documentation, data capture and opportunities for utilization are compliant, accurate and consistent. The Memorial Healthcare System is committed to "Deeper Caring. Smarter Healthcare." and invites individuals to share in the Memorial Experience where touching lives, lifting spirits, and healing the human body is the profession's greatest privilege and reward.

Requirements

• Medical Doctor (Required)
• Medical Doctor License (ME LICENSE) - State of Florida (FL)
• Osteopathic Physician License (OS LICENSE) - State of Florida (FL)
• Requires critical thinking skills, effective communication, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action when required.
• 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

• 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.
• 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.
• Works in collaboration with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to maintain and improve utilization and documentation efforts.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree
• Number of Employees: 5,001-10,000 employees