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

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 reputed company, managed Medicare and reputed company 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 reputed company) 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 reputed company Baroness Hospital Chattanooga, TN Physician Advisor - Utilization Mgmt (Part-Time / Remote) Standard Hours Regular Apply Job!