PHYSICIAN ADVISOR (MEDICAL DIRECTOR UTILIZATION REVIEW) (22920255)

Location: Washington
Duration: Permanent - Full Time
Job ID: 22920255
Company: C.O. Clover Group, Inc
Contact: C.O. Clover Group, Inc    Call: 6823479429
Job Updated: 06/08/21

PHYSICIAN ADVISOR (MEDICAL DIRECTOR UTILIZATION REVIEW) - 22920255

Seeking a Physician Advisor/Medical Director Utilization Review

  • The Medical Director conducts clinical reviews on cases referred by care management staff to meet regulatory requirements and in accordance with the hospitals’ objectives for assuring quality patient care and effective, efficient utilization of health care services.  
  • The Medical Director meets with care management and health care team members to discuss selected cases and make recommendations for care, interacting with medical staff members and medical directors of third-party payers to discuss the needs of patients and alternative levels of care.  
  • The Medical Director acts as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources.  
Duties:
  • Co-Chairs Utilization Management Committee. Serve as second level reviewer for UM, providing guidance on appropriate/alternative levels of care based on InterQual guidelines and other appropriate criteria.
  • Function as consultant to and resource for attending physicians regarding their decisions relative to appropriateness of hospitalization, continued stay, and use of resources. Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization, alternative levels of care, community resources, and end of life care.
  • Acts as a liaison with payers to facilitate approvals and prevent denials or carved out days when appropriate.  Facilitates, mentors, and educates other physicians regarding payer requirements.
  • Support Clinical Documentation Integrity (CDI) with education to attending physicians about ICD coding guidelines, co-morbid conditions and clinical terminology to improve their understanding of severity, acuity, risk of mortality and DRG assignments.
  • Additional Job Functions as deemed appropriate and warranted.


EXPERIENCE/TRAINING:

Experience and success in leading and facilitating groups of physicians.

Two years utilization management experience as a member of the UM Committee or past physician advisor experience preferred.

 

SKILLS AND CERTIFICATIONS:

 
Licensure as a Physician in WA state
Federal DEA number.
2-Years utilization management experience required.