Physician Advisor UR and CDI-Utilization Management

About the Role

The Physician Advisor is a key member of the healthcare organization’s leadership team, responsible for meeting the organization’s goals and objectives in ensuring the effective and efficient utilization of health care services. This role involves teaching, consulting, and advising the Clinical Documentation Improvement and Utilization Review departments, as well as hospital leadership. The Physician Advisor develops expertise in physician practice patterns, resource utilization, medical necessity, levels of care, denial management, compliance with regulations, and physician coding and documentation requirements.

Responsibilities

• Teach, consult, and advise the Clinical Documentation Improvement and Utilization Review departments.
• Advise hospital leadership on matters related to utilization management and patient care.
• Develop expertise in physician practice patterns, resource utilization, medical necessity, levels of care, denial management, and compliance with governmental and private payer regulations.
• Ensure appropriate physician coding and documentation requirements are met.

Qualifications

• 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 utilization management, quality improvement, and patient safety.
• Have a working knowledge of hospital organization, case management operations, and administrative standards and policies.
• Demonstrate strong computer skills and proficiency with the EMR.
• Familiarity with MCG/Interqual placement status criteria is preferred.

Schedule

This position is authorized for 80.00 hours bi-weekly, with working hours from 8 AM to 5 PM, Monday through Friday.