Utilization Management Physician Advisor

Intermountain Health

3d•$7 - $1,000•Onsite

About The Position

Physician will provide Physician Advisor Utilization Reviewer and Central Appeals Work services. Physician shall engage, educate, and coach physicians and other clinicians in appropriate documentation of medical necessity for hospital admissions and other diagnostic and therapeutic interventions in IHCHS hospitals and/or geographic regions as assigned. Physician shall work in partnership with the utilization review committee to ensure procedures are in place to follow all rules and regulations and maintain compliance. Physician shall serve as an expert and local resource to hospital Case Management Department and Medical Staff on issues relating to clinical documentation and medical necessity. In addition, Physician shall work closely with the Medical Director (Executive/Community/Rural), Nursing Administrator, Case Management Director, and Finance Director. Work with and support the Case Management Department to ensure appropriate admission and discharge status and timing. Be a consistent resource for physicians and case managers on issues relating to clinical documentation, appropriate admission status, and patient flow. Provide oversight and coordination of physician education and coaching on regulatory issues. Participate and provide physician expertise for appeals in coordination with R1 Central Appeals Unit (“CAU”). Attend System Utilization Review (“UR”) Committee and provide Regional Physician Advisor Educators information to be shared at Regional UR Committees as assigned. Perform high level utilization review on a population basis to help guide compliance and educational efforts. Work with other IHCHS Physician Advisors and provide service to other regions as needed. Work under direct supervision of the IHCHS Chief Patient Experience Officer and IHCHS System Physician Advisor. Participate in other IHCHS meetings as needed. Add Utilization Review shifts as directed by System Physician Advisor. Oversee Intermountain Physician Advisor Services (“IPAS”) Utilization Review physicians and nurses in conjunction with System Physician Advisor. Coordinate Tertiary Review schedule and completion. Physician will need to arrange for another IPAS physician to be on-call as the second IPAS reviewer for those cases where Physician is the original IPAS reviewer and a second IPAS reviewer is required. Obtain and distribute pertinent UR data to IPAS UR team and IHCHS leadership as appropriate. Oversee IPAS UR physicians and nurses to arrange monthly meetings, agendas, schedule and ad hoc education in conjunction with System Physician Advisor. Work with System Utilization Review Manager and others to adjust UR workflow to reflect current trends and documentation requirements. Give feedback to IPAS UR physicians and Case Management regarding denials to enable adjustments to front-end practice.

Requirements

Medical Doctor or Doctor of Osteopathic Medicine Degree. Education must be obtained through an ACGME or AOA accredited institution. Degree will be verified.
ABMS or equivalent AOA Board Certification
Active Utah or Idaho Medical Licensure, or in process of obtaining licensure.
Two years of experience leading successful improvements in clinical settings.
Experience with change management with the ability to provide leadership in the adaptation and implementation of new processes or technology that enhance safety.
Effective verbal, written, and interpersonal communication skills.
Interact with others requiring employee to verbally communicate as well as hear and understand spoken information.
Operate computers, telephones, office equipment, and manipulate paper requiring the ability to move fingers and hands.
See and read computer monitors and documents.
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Nice To Haves

Trained in improvement science (i.e., Six Sigma, Lean, Project management, Advanced Training Program).
Experience working in a complex health system (e.g., hospitals, ambulatory clinics, post-acute care).
Demonstrated leadership of clinicians.

Responsibilities

Provide Physician Advisor Utilization Reviewer and Central Appeals Work services.
Engage, educate, and coach physicians and other clinicians in appropriate documentation of medical necessity for hospital admissions and other diagnostic and therapeutic interventions in IHCHS hospitals and/or geographic regions as assigned.
Work in partnership with the utilization review committee to ensure procedures are in place to follow all rules and regulations and maintain compliance.
Serve as an expert and local resource to hospital Case Management Department and Medical Staff on issues relating to clinical documentation and medical necessity.
Work closely with the Medical Director (Executive/Community/Rural), Nursing Administrator, Case Management Director, and Finance Director.
Work with and support the Case Management Department to ensure appropriate admission and discharge status and timing.
Be a consistent resource for physicians and case managers on issues relating to clinical documentation, appropriate admission status, and patient flow.
Provide oversight and coordination of physician education and coaching on regulatory issues.
Participate and provide physician expertise for appeals in coordination with R1 Central Appeals Unit (“CAU”).
Attend System Utilization Review (“UR”) Committee and provide Regional Physician Advisor Educators information to be shared at Regional UR Committees as assigned.
Perform high level utilization review on a population basis to help guide compliance and educational efforts.
Work with other IHCHS Physician Advisors and provide service to other regions as needed.
Work under direct supervision of the IHCHS Chief Patient Experience Officer and IHCHS System Physician Advisor.
Participate in other IHCHS meetings as needed.
Add Utilization Review shifts as directed by System Physician Advisor.
Oversee Intermountain Physician Advisor Services (“IPAS”) Utilization Review physicians and nurses in conjunction with System Physician Advisor.
Coordinate Tertiary Review schedule and completion.
Arrange for another IPAS physician to be on-call as the second IPAS reviewer for those cases where Physician is the original IPAS reviewer and a second IPAS reviewer is required.
Obtain and distribute pertinent UR data to IPAS UR team and IHCHS leadership as appropriate.
Oversee IPAS UR physicians and nurses to arrange monthly meetings, agendas, schedule and ad hoc education in conjunction with System Physician Advisor.
Work with System Utilization Review Manager and others to adjust UR workflow to reflect current trends and documentation requirements.
Give feedback to IPAS UR physicians and Case Management regarding denials to enable adjustments to front-end practice.

Benefits

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits package here.
Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more.

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