Pediatric Physician Advisor - Centralized Utilization Review - FT - Days - MHS

Memorial Healthcare System; Town of Florida (NY); On-site; USD 180,000 - 230,000; Full time

Job summary

Memorial Healthcare System is seeking a physician leader to ensure documentation and utilization are compliant, accurate, and consistent across the hospital system. You will collaborate with UR/HIM, medical staff, and health plans to optimize pre-admission decisions, medical necessity determinations, and transfers.

The role requires a Medical Doctor with Florida licensure, strong critical thinking, and the ability to educate staff on utilization review processes.

Qualifications

• Medical Doctor required with Florida medical license.
• Graduate of a medical school approved by the AMA.
• Experience in Utilization Management preferred.

Responsibilities

• Collaborate with Centralized UR/HIM and medical staff to improve utilization and documentation.
• Make decisions on pre-admission, authorization, medical necessity and services/setting, transfers and continued stay.
• Conduct peer-to-peer discussions with health plans when required.
• Educate medical staff on utilization review and documentation benefits.
• Perform regular chart audits for accuracy of clinical documentation and utilization.
• Ability to work weekends and holidays as needed.

Skills

critical thinking

effective communication

decisive judgement

minimal supervision

Education

Medical Doctor

ME license Florida

OS license Florida

Job description

Location

Fort Lauderdale, Florida

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary

Ensures documentation, data capture and opportunities for utilization are compliant, accurate and consistent.

Responsibilities

Works in collaboration with the Medical Director of Centralized UR/HIM, utilization committees and medical staff to maintain and improve utilization and documentation efforts. Makes decisions on referred individual patient cases regarding: Pre-admission, authorization, Medical necessity and services/setting, transfers, appropriateness of admission, and continued stay. Conducts peer to peer discussions with health plans when required. Serves as a resource to the medical staff for Utilization Review activities. Educates and communicates to the medical staff the benefits/need for utilization review and documentation. Performs regular, follow-up and focused chart audits/reviews (concurrent and retrospective) for the purpose of assessing the accuracy of clinical documentation and utilization. Ability to work weekends and holidays as needed.

Education and Certification Requirements

Medical Doctor (Required) Medical Doctor License (ME LICENSE) - State of Florida (FL), Osteopathic Physician License (OS LICENSE) - State of Florida (FL)

Additional Job Information

Complexity of Work: Requires critical thinking skills, effective communication, decisive judgment and the ability to work with minimal supervision. The incumbent must be able to work in a stressful environment and take appropriate action when required. Required Work Experience: Minimum of 1 year of work experience in a clinical setting Other Information: Prior experience in Utilization Management with hospital system or health system preferred Additional Education Info: Graduate of a medical school approved by the Council on Medical Education of the American Medical Association.

Working Conditions And Physical Requirements

• Bending and Stooping = 60%
• Climbing = 40%
• Keyboard Entry = 100%
• Kneeling = 40%
• Lifting/Carrying Patients 35 Pounds or Greater = 0%
• Lifting or Carrying 0 - 25 lbs Non-Patient = 60%
• Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%
• Lifting or Carrying > 75 lbs Non-Patient = 0%
• Pushing or Pulling 0 - 25 lbs Non-Patient = 60%
• Pushing or Pulling 26 - 75 lbs Non-Patient = 0%
• Pushing or Pulling > 75 lbs Non-Patient = 0%
• Reaching = 60%
• Repetitive Movement Foot/Leg = 40%
• Repetitive Movement Hand/Arm = 100%
• Running = 0%
• Sitting = 100%
• Squatting = 80%
• Standing = 80%
• Walking = 80%
• Audible Speech = 100%
• Hearing Acuity = 100%
• Smelling Acuity = 0%
• Taste Discrimination = 0%
• Depth Perception = 60%
• Distinguish Color = 60%
• Seeing - Far = 60%
• Seeing - Near = 60%
• Bio hazardous Waste = 40%
• Biological Hazards - Respiratory = 0%
• Biological Hazards - Skin or Ingestion = 0%
• Blood and/or Bodily Fluids = 40%
• Communicable Diseases and/or Pathogens = 0%
• Asbestos = 0%
• Cytotoxic Chemicals = 0%
• Dust = 0%
• Gas/Vapors/Fumes = 0%
• Hazardous Chemicals = 0%
• Hazardous Medication = 0%
• Latex = 0%
• Computer Monitor = 80%
• Domestic Animals = 40%
• Extreme Heat/Cold = 40%
• Fire Risk = 0%
• Hazardous Noise = 0%
• Heating Devices = 0%
• Hypoxia = 0%
• Laser/High Intensity Lights = 0%
• Magnetic Fields = 0%
• Moving Mechanical Parts = 0%
• Needles/Sharp Objects = 0%
• Potential Electric Shock = 0%
• Potential for Physical Assault = 40%
• Radiation = 0%
• Sudden Decompression During Flights = 0%
• Unprotected Heights = 0%
• Wet or Slippery Surfaces = 0%

Shift

Primarily for office workers - not eligible for shift differential

Disclaimer

This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process.

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.

Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law.

We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.

Employment is subject to post offer, pre-placement assessment, including drug testing.

If you need reasonable accommodation during the application process, please call 954-276-8340 (M-F, 8am-5pm) or email [e-mail]