Physician Advisor Utilization Management
: Job Details :

Conducts clinical review on cases referred by case management staff and/or other health care professionals in accordance with the hospitals Utilization Review guidelines to ensure efficient utilization of health care services and to meet regulatory requirements. Meets with case management and health care team members to discuss selected cases and make recommendations for care. Interacts with medical staff members and medical directors of third party 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. The physician advisor will act as a liaison between the Medical Documentation team (CDI), HIM, and the hospital's medical staff to facilitate accurate and complete documentation. Job Requirements: Required: Graduate of an accredited Family Medicine or Internal Medicine residency. Current New York State license to practice medicine. Preferred: Additional education in quality and utilization management through continuing medical education programs and self-study. Minimum of 5 years recent experience in clinical practice. Utilization management experience as a member of a UM committee or past physician advisor experience. Experience in documentation optimization, coding education and denials management preferred. Monday-FridayNo Call RequiredBase Pay: $250,000 + based one experience