Pediatric Centralized Utilization Review Physician Advisor

Memorial Healthcare; United States; On-site; USD 180,000 - 240,000; Full time

Job summary

Memorial Healthcare System is seeking a physician responsible for utilization review to ensure documentation, data capture, and utilization opportunities are compliant, accurate and consistent.

You will collaborate with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to improve utilization and documentation; decide on pre-admission, medical necessity, services/setting, transfers and continued stay; perform chart audits and educate staff on UR benefits.

Qualifications

• Medical Doctor required and licensed in Florida.
• Active Florida Medical License or Florida Osteopathic Physician License required or pending.
• Experience in Utilization Management or hospital system preferred.

Responsibilities

• Collaborate with the Medical Director of Centralized UR/HIM to enhance utilization and documentation.
• Make decisions on pre-admission, authorization, medical necessity, services/setting, transfers and continued stay.
• Conduct peer-to-peer discussions with health plans when required and serve as UR resource to medical staff.
• Educate medical staff on utilization review processes and documentation standards.
• Perform regular concurrent and retrospective chart audits to assess documentation accuracy.
• May require weekend and holiday work as needed.

Skills

Utilization Review

Clinical Documentation

Communication

Decision Making

Education

Medical Doctor

Florida Medical License

Osteopathic Physician License (FL)

Job description

Memorial Healthcare System is seeking a physician responsible for utilization review to ensure documentation, data capture, and utilization opportunities are compliant, accurate and consistent.

You will collaborate with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to improve utilization and documentation; decide on pre-admission, medical necessity, services/setting, transfers and continued stay; perform chart audits and educate staff on UR benefits.