Physician Advisor UR and CDI-Utilization Management

About the role

The Physician Advisor is a key member of the healthcare organization’s leadership team and is charged with meeting the organization’s goals and objectives for assuring the effective, efficient utilization of health care services. The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the Clinical Documentation Improvement and Utilization Review departments and the hospital leadership. Department: Utilization Management. Shift: Day.

Responsibilities

• Develop expertise on physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, denial management.
• Ensure compliance with governmental and private payer regulations.
• Ensure appropriate physician coding and documentation requirements.

Requirements

• Hold and maintain an unrestricted medical license in the state of (location).
• Meet the requirements (and become a member) of the Hospital medical staff.
• Possess or acquire a solid foundation, knowledge, and/or experience in the areas of utilization management, quality improvement, and patient safety.
• Possess a working knowledge of (Hospital) organization & case management operations and administrative standards and policies.
• Strong computer skills and working knowledge of the EMR.
• Familiarity with MCG/Interqual placement status criteria is preferred.

Schedule

Working Hours: 8‑5P (80.00 hours bi‑weekly).