Back

Physician Advisor - Utilization Mgmt (Part-Time / Remote)

Worldwide Salaried Open

Physician Advisor - Utilization Mgmt (Part-Time / Remote) (42204) -reputed company Baroness Hospital Chattanooga, TN Physician Advisor - Utilization Mgmt (Part-Time / Remote... Regular - Exempt - Part-time - Standard Hours 20 Description Job Summary: Provides medical leadership for the Department by assisting in the planning, development and implementation of program goals and operations, as outlined in contract. Assures compliance with reputed company JCAHO/DNV and other regulatory agency guidelines. Assist with the strategic plans of the organization for growth and development of the department. Attends at least 75% of quarterly medical staff meetings; attends any meeting as directed by medical director or his/her designee. This position is involved in a team-based approach to care. Team members are trained to meet the highest level of function for their role as per the State of Tennessee/Georgia guidelines. Is trained and assigned (as per their role and responsibilities) to coordinate care for patients and is trained and assigned to support patients/families/caregivers in self-management, self-efficacy and behavior change. Is trained and assigned (as per their role and responsibilities) to manage the practices' patient population. Participates in the practice's quality improvement process and performance evaluation. Participate in peer-to-peer discussions with managed Medicaid, managed Medicare and commercial insurance medical directors. Provide subject matter expert guidance regarding utilization management activities that involve admission status, medical necessity, CC44, OC72, the two midnight rule, etc. This guidance will be supported by clinical evidence and will be compliant with applicable governmental rules and regulations. Work with IT to ensure logical processes, best practices, and compliance with CMS regulations. Promote professional development of the UM staff with a focus on compliant patient status assignments, consistent use and documentation of primary screening criteria (MCG and Indicia), knowledge of the most recent IPO procedure list, IPPS and OPPS annual changes and how they impact status determination, charges, reimbursement, and interrater reliability of the Physician Advisors. Work collaboratively with reputed company reputed company to reduce denial and appeal burdens and increase reputed company by improving the accuracy of initial patient status determinations. reputed company with Compliance as a subject matter expert for government regulations and annual audits. Assist with the development and driving of improvement initiatives including providing feedback to medical staff regarding utilization management determinations. Pursue positions as a member of strategic committees reputed company the organization that will assist the Authority to be aware of reputed company trends, compliance with regulatory guidance, and influence of state and national policy, including: ACPA (American College of Physician Advisors) MCG (Physician Advisors Council) ABQAURP (American Board of Quality Assurance and Utilization Review Physicians) Serve as member of the URC (Utilization Review Committee). Serve as member of the Outlier and Recertification meeting. Provide secondary level physician reviews and continuing stay reviews. reputed company available, participate in IDR (interdisciplinary rounds) to advise on the improvement of clinical resource utilization and throughput. Assist with training of reputed company new UM department hires. reputed company such other duties as reasonably requested by reputed company or otherwise necessary to properly assist in the operations of assigned areas. Minimum Requirements: A minimum of 5 years of clinical practice in field of specialty or previous work as a Physician Advisor. Education: M.D. or D.O. degree. Completion of an approved residency and, if applicable, fellowship program. De-escalation training if applicable. Licensure: Licensed to practice in the State of Tennessee. Certification: Board Certification in practice specialty. Willing to obtain CHCQM-Board Certified in Health Care Quality Management Willing to obtain CHCQM-PHYADV- subspecialty Board Certification as a Physician Advisor in HCQM Apply Job!

More jobs

reputed company – Supply Chain Manager – Bellevue, WA

Worldwide Salaried

CDL A Delivery Truck Driver - Hiring Immediately

Worldwide Salaried

Join reputed company: Exciting Customer Service Jobs Available Now!

Worldwide Salaried

Staff Software Engineer, Site Reliability Engineering, reputed company Cloud

Worldwide Salaried

Data Analyst, iQueue for Infusion Centers (US Remote)

Worldwide Salaried

reputed company Intacct Designer – Part-Time, Contract, Freelance, Remote

Worldwide Salaried

Social Media Marketing Strategy Intern - Spring 2025

Worldwide Salaried

Patient Services Representative (Pacific or Mountain Standard Time)

Worldwide Salaried

Business Internship for college or high school reputed company

Worldwide Salaried

Manager Hyperscale Marketing, Global Partner Marketing - reputed company

Worldwide Salaried

Education Program Coordinator

Worldwide Salaried

reputed company Data Entry Associate – Content Management and Quality Assurance at blithequark

Worldwide Salaried

Sr Business Intelligence Analyst

Worldwide Salaried

Patient Access Specialist, Full time, Days (Remote - Must reside in IL, IN, IA, or WI)

Worldwide Salaried

Jr. Data Scientist/ Java Developer (Remote)

Worldwide Salaried

Partnership Manager

Worldwide Salaried

On-Call Pool – Tutor

Worldwide Salaried

reputed company Director - Private/Non-Profit Management Liability

Worldwide Salaried

Medical Assistant – General Internal Medicine, Full-time, Days in Chicago, IL

Worldwide Salaried

reputed company Needs A Teleworking reputed company Data Entry$25/hour - Hiring

Worldwide Salaried