Utilization Management Physician

Naphcare, Inc.•Vestavia Hills, AL

1d•Onsite

About The Position

NaphCare is hiring a Utilization Management Physician to join our team at our Corporate Office in Birmingham, AL. The Utilization Management Physician will provide a streamlined, efficient, and consistent approach to the quality of patient care while supplementing onsite resources to prioritizing continuity of care, ensuring accuracy and follow through of care plans related to offsite patient encounters that focus on site resource availability and appropriate utilization.

Requirements

A current unrestricted license as a Physician in the state of employment
Hold a current DEA registration
Have a valid CPR card. (BLS required)
A minimum of 2-years experience in primary care with correctional healthcare preferred
Must possess strong written communication and verbal skills and have strong computer skills

Responsibilities

Review of offsite/specialty Returns, hospital returns (inpatient or observation status), and ER returns. Completing detailed review of records to make sure all consultant recommendations are reviewed and implemented, along with submitting follow up consult visits as recommended.
Site Maintenance to review facility queues. This is to ensure timely follow up in signing off orders and reordering medications. Sharing educational needs that are identified for providers and nursing to education department for follow up/training.
Review diabetic acuity reports, medical priority dashboard, and Coumadin patients charts to ensure plan of care, orders, appointments, etc. are appropriate and being monitored/followed by site or corporate provider.
Use knowledge and expertise to ensure that processes and systems are followed appropriately according to policies and procedures, company performance, and accreditation standards. Support peer review process per NCCHC standards.
Use all functions and applications of TechCare® relevant to the position with no supervision.
Communicate effectively with clients, peers, and employees at all levels within the organization. Maintain clear lines of communication throughout issue-resolution processes.
Demonstrate personal performance based on professional practice standards, relevant statutes, rules and regulations, and organizational criteria.
Demonstrate professionalism by using objectivity, maintaining self-control when under pressure, separating professional from personal issues, displaying emotional maturity, maintaining a high degree of integrity, and promoting a positive work environment by setting an example.
Participate when indicated in all monthly, quarterly, and annual meetings as assigned and required in accordance with contract compliance.
Relay critical information to the next level of management that may have a negative impact on client and/or vendor relations or patient care.