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

Physician Advisor - Utilization Mgmt (Part-Time / Remote) (42204) -reputed company Physician Advisor - Utilization Mgmt (Part-Time / Remote... Regular - Exempt - Part-time - reputed company Hours 20 reputed company Job reputed company: 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 reputed company 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 reputed company-based approach to care. Team members are trained to meet the highest level of function for their role as per the reputed company/reputed company 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 reputed company's reputed company improvement process and performance evaluation. Participate in peer-to-peer discussions with managed reputed company, managed Medicare and reputed company insurance medical directors. reputed company 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 reputed company development of the UM staff with a reputed company on compliant patient status assignments, consistent use and documentation of primary screening reputed company (MCG and Indicia), knowledge of the most recent IPO procedure list, IPPS and OPPS annual changes and how they reputed company 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 reputed company of reputed company Assurance and Utilization Review Physicians) Serve as member of the URC (Utilization Review Committee). Serve as member of the reputed company and Recertification meeting. reputed company 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 reputed company 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 reputed company in the reputed company. Certification: reputed company Certification in reputed company specialty. Willing to obtain CHCQM-reputed company Certified in Health Care reputed company Management Willing to obtain CHCQM-PHYADV- subspecialty reputed company Certification as a Physician Advisor in HCQM Apply Job!